| Space Coast Health Centers Inc | |
|
951 N Washington Ave Ste 100 Titusville FL 32796-2163 | |
| (386) 852-9565 | |
| Not Available |
| Full Name | Space Coast Health Centers Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 951 N Washington Ave Ste 100, Titusville, Florida |
| Authorized Official Name and Position | Arvin Lewis (CEO) |
| Authorized Official Contact | 3212686836 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Space Coast Health Centers Inc 951 N Washington Ave Ste 100 Titusville FL 32796-2163 Ph: (386) 852-9565 | Space Coast Health Centers Inc 951 N Washington Ave Ste 100 Titusville FL 32796-2163 Ph: (386) 852-9565 |
| NPI Number | 1144819319 |
|---|---|
| Provider Enumeration Date | 01/13/2021 |
| Last Update Date | 02/08/2024 |
| Certification Date | 02/08/2024 |
| Medicare PECOS PAC ID | 8224445531 |
|---|---|
| Medicare Enrollment ID | O20210405001096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144819319 | NPI | - | NPPES |
| Provider Name | Vidya N Hate |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1043312945 PECOS PAC ID: 1850384983 Enrollment ID: I20040405001880 |
| Provider Name | Jason C Wieseler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528095544 PECOS PAC ID: 2365451929 Enrollment ID: I20060417000046 |
| Provider Name | Cara Starkey |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1063685774 PECOS PAC ID: 3577637040 Enrollment ID: I20080731000505 |
| Provider Name | Johanna B Pillado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629686415 PECOS PAC ID: 5294150553 Enrollment ID: I20210405000973 |
| Provider Name | Zackary Besner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609364728 PECOS PAC ID: 9032515986 Enrollment ID: I20210901002109 |
| Provider Name | Renee Soucier |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972088631 PECOS PAC ID: 0840683660 Enrollment ID: I20220131001099 |
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