PROVECTUS HEALTH LLC


Address: 3972 Durksly Dr, Melbourne, FL 32940-1286
Phone: 3056136424

PROVECTUS HEALTH LLC (NPI# 1659990364) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1659990364
Entity Type Organization
Organization Name PROVECTUS HEALTH LLC
Practice Address 3972 Durksly Dr
Melbourne
FL 32940-1286
Practice Telephone 3056136424
Mailing Telephone 3056136424
Enumeration Date 2020-04-13
Last Update Date 2020-04-13
Authorized Official Name ALDO GONZALEZ-BEICOS (AUTHORIZED OFFICIAL)
Authorized Official Telephone 3056136424
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QR0200X Clinic/Center
Specialization: Radiology
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
FL ME115800 ME115800 01

Office Location

Street Address 3972 DURKSLY DR
City MELBOURNE
State FL
Zip Code 32940-1286

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Taxonomy Information

Taxonomy Code 261QR0200X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Radiology

Taxonomy Definition

Definition to come...

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Competitor

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City MELBOURNE
Zip Code 32940

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Dataset Information

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.

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