| Neurologic Associates Of Central Brevard Inc | |
|
1395 N Courtenay Pkwy Suite #106 Merritt Island FL 32953-4400 | |
| (321) 452-1224 | |
| (321) 453-7784 |
| Full Name | Neurologic Associates Of Central Brevard Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1395 N Courtenay Pkwy, Merritt Island, Florida |
| Authorized Official Name and Position | Patricia Valluzzi (OFFICE MANAGER) |
| Authorized Official Contact | 3214521224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurologic Associates Of Central Brevard Inc 1395 N Courtenay Pkwy Suite #106 Merritt Island FL 32953-4400 Ph: (321) 452-1224 | Neurologic Associates Of Central Brevard Inc 1395 N Courtenay Pkwy Suite #106 Merritt Island FL 32953-4400 Ph: (321) 452-1224 |
| NPI Number | 1295937373 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 01/10/2012 |
| Medicare PECOS PAC ID | 7416124334 |
|---|---|
| Medicare Enrollment ID | O20120118000273 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295937373 | NPI | - | NPPES |
| 053783700 | Medicaid | FL | |
| 77741 | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Roberto Mixco |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396805255 PECOS PAC ID: 6507033420 Enrollment ID: I20120118000694 |
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