| Brevard Wound Care Center, Llc | |
|
445 Pineda Ct Melbourne FL 32940-7555 | |
| (321) 254-1611 | |
| (321) 254-3166 |
| Full Name | Brevard Wound Care Center, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 445 Pineda Ct, Melbourne, Florida |
| Authorized Official Name and Position | Miguel Mateos-mora (OWNER/OPERATOR) |
| Authorized Official Contact | 3212541611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brevard Wound Care Center, Llc 445 Pineda Ct Melbourne FL 32940-7555 Ph: (321) 254-1611 | Brevard Wound Care Center, Llc 445 Pineda Ct Melbourne FL 32940-7555 Ph: (321) 254-1611 |
| NPI Number | 1154910271 |
|---|---|
| Provider Enumeration Date | 01/13/2021 |
| Last Update Date | 01/13/2021 |
| Medicare PECOS PAC ID | 3274948419 |
|---|---|
| Medicare Enrollment ID | O20210219001551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154910271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Miguel Mateos-mora |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1992790851 PECOS PAC ID: 1456525146 Enrollment ID: I20111115000143 |
| Provider Name | Simone A King Paul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972054864 PECOS PAC ID: 2264719632 Enrollment ID: I20170512000789 |
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