SPACE COAST VOLUNTEERS IN MEDICINE (NPI# 1467712695) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467712695 |
| Entity Type | Organization |
| Organization Name | SPACE COAST VOLUNTEERS IN MEDICINE |
| Practice Address |
1460 Baytree Dr Ne Palm Bay FL 32905-3900 |
| Practice Telephone | 3219140915 |
| Practice Fax Number | 3219140916 |
| Mailing Telephone | 3219140915 |
| Mailing Fax Number | 3219140916 |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2012-06-05 |
| Authorized Official Name | STEVEN VANDERBY (CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 3217258222 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | ME0059801 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
1460 BAYTREE DR NE |
| City | PALM BAY |
| State | FL |
| Zip Code | 32905-3900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174803340 | Ronald Gene List | Dentist | 1460 Baytree Dr Ne, Palm Bay, FL 32905-3900 | 2011-08-19 |
| 1952667966 | Audrey C Joiner | Nurse Practitioner | 1460 Baytree Dr Ne, Palm Bay, FL 32905-3900 | 2012-04-03 |
| 1306120548 | Richard Neil Baney | Internal Medicine | 1460 Baytree Dr Ne, Palm Bay, FL 32905-3900 | 2011-10-06 |
| 1629350160 | Sheryl Arlynn Wilson | Nurse Practitioner | 1460 Baytree Dr Ne, Palm Bay, FL 32905-3900 | 2011-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306460928 | Lavell Woodard Jr. | Counselor | 4206 Pinewood Dr Ne, Palm Bay, FL 32905 | 2020-05-29 |
| 1548735699 | Aaron J Milton | Counselor | 1420 Sportsman Lane Ne, Palm Bay, FL 32905 | 2018-10-04 |
| 1871070417 | The Brevard Health Alliance Inc | Clinic/Center | 1361 Florida Ave Ne Ste 2, Palm Bay, FL 32905 | 2018-07-26 |
| 1699266361 | Coastal Visioncare LLC | Optometrist | 2186 Harris Ave Ne Ste 1, Palm Bay, FL 32905 | 2018-05-29 |
| 1184173981 | Jean Elyse Gautreaux | Social Worker | 2475 Palm Bay Rd Ne, Suite 130 #4, Palm Bay, FL 32905 | 2016-09-22 |
| 1174901607 | Reginald Shannon Seecharan | Developmental Therapist | 700 James Cir Ne, Palm Bay, FL 32905 | 2015-05-17 |
| 1881091254 | Courtney Taft | Physical Therapy Assistant | 1155 Malabar Road, Suite 1, Palm Bay, FL 32905 | 2014-12-01 |
| 1548513310 | Juda Marie Decara | Counselor | 4690 Lipscomb St Se, Suite 6c, Palm Bay, FL 32905 | 2012-10-18 |
| 1326308313 | Mohammad Idrees Md, P.a. | Internal Medicine | 1454 Belaire Lane N.e., Palm Bay, FL 32905 | 2012-05-23 |
| 1265704548 | Atm Amin Dds LLC | Dentist | 4620 Lipscomb St Ne, Suite 2, Palm Bay, FL 32905 | 2012-02-02 |
| Find all providers in zip 32905 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194147611 | Carl Glenmore Morrison Sr. | General Practice | 2125 Windbrook Drive, Palm Bay, FL 32909 | 2014-01-17 |
| 1184799272 | Victor A Arana | General Practice | 1663 Georgia St Ne, Suite 500, Palm Bay, FL 32907-2503 | 2006-11-22 |
| 1558849885 | The Brevard Health Alliance, Inc. | General Practice | 1361 Florida Ave Ne Ste 2, Palm Bay, FL 32905 | 2018-07-30 |
| 1790948941 | Sunshine Walk In Clinic | General Practice | 5205 Babcock St Ne, Suite 3, Palm Bay, FL 32905-4638 | 2008-07-08 |
| 1205026291 | Vicdia L Sostre Concepcion | General Practice | 5270 Babcock St Ne Ste 1, Palm Bay, FL 32905-4616 | 2007-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265033823 | Bless Medical Center of Nmb LLC | General Practice | 1400 Ne Miami Gardens Dr Ste 209, North Miami Beach, FL 33179-4844 | 2020-11-02 |
| 1982203634 | Central Florida Wellness LLC | General Practice | 15516 W Colonial Dr Ste 111, Winter Garden, FL 34787-9558 | 2020-10-23 |
| 1760080212 | Summit Health Multi Specialty of Florida LLC | General Practice | 1881 W Kennedy Blvd Ste D, Tampa, FL 33606-1611 | 2020-10-15 |
| 1376140772 | Amy Wrenn | General Practice | 155 Cranes Roost Blvd Ste 2020-a, Altamonte Springs, FL 32701-3468 | 2020-10-08 |
| 1992302574 | Avita Medical Clinic, LLC | General Practice | 14831 N Florida Ave, Tampa, FL 33613-1825 | 2020-10-06 |
| 1568069672 | Ernesto Oscar Gonzalez Pupo | General Practice | 14420 Sw 22nd St, Miami, FL 33175-6338 | 2020-10-02 |
| 1508463779 | Ashley Zanders Walton | General Practice | 75 Foxfire Ct, Quincy, FL 32351-7293 | 2020-10-01 |
| 1730796830 | Brid M Wade | General Practice | 3199 Cornell Dr, Gulf Breeze, FL 32563-2785 | 2020-09-23 |
| 1902412786 | New Era Medical Pllc | General Practice | 628 Cleveland St Ste A, Clearwater, FL 33755-6603 | 2020-09-17 |
| 1417562414 | Jl Laria Aprn Pa | General Practice | 5751a Sw 40th St, Miami, FL 33155-5301 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.