Space Coast Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SPACE COAST MEDICAL CENTER

Practice address

3550 S Washington Ave
Suite 24
Titusville, FL 32780-8627

Phone

(321) 269-5533

Fax

(321) 269-3009

NPI assigned

Dec 2, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary Harrison

Title

Vice President

Phone

(321) 269-5533

Specialties & licenses 1

Addresses

Tax ID family

Space Coast Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Space Coast Pain Relief Inc.

  • Health Maintenance Organization
  • Titusville, FL
  • NPI 1841328002
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291248000000",
    "number": "1982906582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 S WASHINGTON AVE",
            "address_2": "SUITE 24",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327808627",
            "telephone_number": "321-269-5533",
            "fax_number": "321-269-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 S WASHINGTON AVE",
            "address_2": "SUITE 24",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327808627",
            "telephone_number": "321-269-5533",
            "fax_number": "321-269-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-02",
        "last_updated": "2010-12-02",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "321-269-5533",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Living of Titusville
• Sovereign Healthcare of Titusville, LLC
• Space Coast Assisted Living LLC
• Space Coast Health Centers Inc
• Space Coast Medical Associates LLP
• Space Coast Medical Consultants PLLC
• Space Coast Ophthalmology LLC
• Space Coast Pain Relief Inc.
• Space Coast Radiology Associates
• Space Coast Urology, LLC

• Family Medicine Physician in Titusville, FL
• Providers in Titusville, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.