| Brevardpicc | |
|
4154 San Ysidro Way Rockledge FL 32955-5336 | |
| (321) 241-6244 | |
| (833) 301-0862 |
| Full Name | Brevardpicc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4154 San Ysidro Way, Rockledge, Florida |
| Authorized Official Name and Position | Kelly Alise Wey (OWNER/OPERATOR) |
| Authorized Official Contact | 3212437060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brevardpicc 4154 San Ysidro Way Rockledge FL 32955-5336 Ph: (321) 241-6244 | Brevardpicc 4154 San Ysidro Way Rockledge FL 32955-5336 Ph: (321) 241-6244 |
| NPI Number | 1700412814 |
|---|---|
| Provider Enumeration Date | 03/20/2020 |
| Last Update Date | 03/05/2024 |
| Certification Date | 03/05/2024 |
| Medicare PECOS PAC ID | 7214367358 |
|---|---|
| Medicare Enrollment ID | O20200414000260 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700412814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Miguel Mateos-mora |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1992790851 PECOS PAC ID: 1456525146 Enrollment ID: I20111115000143 |
| Provider Name | Simone a King Paul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972054864 PECOS PAC ID: 2264719632 Enrollment ID: I20170512000789 |
| Provider Name | Gerald S Bowman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1043749799 PECOS PAC ID: 2264780089 Enrollment ID: I20180809004984 |
Internal Medicine of Brevard, PLLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1978 Rockledge Blvd, Ste 108, Rockledge, FL 32955 Phone: 321-631-0392 Fax: 321-631-5787 |
Oscar H Jerkins, MD, PA Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9 Orange Ave, Rockledge, FL 32955 Phone: 888-974-5556 |
George Idiculla Md,pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1029 Florida Ave S, Rockledge, FL 32955 Phone: 321-638-0888 |
Francis a Ashie MD PA Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1007 Beverly Dr, Suite C, Rockledge, FL 32955 Phone: 321-636-1834 Fax: 321-636-1694 |
Mental Health Resource Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Barton Blvd Ste 7, Rockledge, FL 32955 Phone: 321-504-3888 Fax: 321-504-3462 |
Endo Health Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5460 Village Drive,viera, Rockledge, FL 32955 Phone: 972-821-1253 |