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2565 Judge Fran Jamieson Way Viera FL 32940-5998 | |
| (321) 637-7700 | |
| (321) 637-7707 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2565 Judge Fran Jamieson Way, Viera, Florida |
| Authorized Official Name and Position | Sharon B. Rosman (PROGRAM ADMINISTRATOR) |
| Authorized Official Contact | 3216377700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2565 Judge Fran Jamieson Way Viera FL 32940-5998 Ph: (321) 637-7700 | 2565 Judge Fran Jamieson Way Viera FL 32940-5998 Ph: (321) 637-7700 |
| NPI Number | 1851439608 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 02/14/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851439608 | NPI | - | NPPES |
| 058384700 | Medicaid | FL | |
| 811059000 | Medicaid | FL | |
| 058384701 | Medicaid | FL | |
| 058384702 | Medicaid | FL | |
| 885356800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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