| Brevard Health Center Pl | |
|
298 Michigan Ave Suite 101 Melbourne FL 32901-3104 | |
| (321) 215-6899 | |
| (321) 215-6789 |
| Full Name | Brevard Health Center Pl |
|---|---|
| Speciality | Internal Medicine |
| Location | 298 Michigan Ave, Melbourne, Florida |
| Authorized Official Name and Position | Aparna Balaji (OPERATING OFFICER) |
| Authorized Official Contact | 3212156899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brevard Health Center Pl 298 Michigan Ave Suite 101 Melbourne FL 32901-3104 Ph: (321) 215-6899 | Brevard Health Center Pl 298 Michigan Ave Suite 101 Melbourne FL 32901-3104 Ph: (321) 215-6899 |
| NPI Number | 1215254073 |
|---|---|
| Provider Enumeration Date | 05/03/2010 |
| Last Update Date | 10/22/2024 |
| Medicare PECOS PAC ID | 6901939735 |
|---|---|
| Medicare Enrollment ID | O20100730000761 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215254073 | NPI | - | NPPES |
| 110199177 | Other | FL | RAIL ROAD MEDICARE |
| 257850600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Gobivenkata Balaji |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649230459 PECOS PAC ID: 3678616133 Enrollment ID: I20100205000189 |
| Provider Name | Cristi D Leeberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982971404 PECOS PAC ID: 3173782216 Enrollment ID: I20120309000389 |
| Provider Name | Shobha Rebala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457731663 PECOS PAC ID: 0840506499 Enrollment ID: I20150827002864 |
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