| Ethos Health Melbourne Llc | |
|
2755 N Wickham Rd Ste 102 Melbourne FL 32935-2226 | |
| (352) 732-5590 | |
| (352) 732-0292 |
| Full Name | Ethos Health Melbourne Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2755 N Wickham Rd Ste 102, Melbourne, Florida |
| Authorized Official Name and Position | Jonathan Walker (OWNER/OPERATOR) |
| Authorized Official Contact | 3527325590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethos Health Melbourne Llc 1541 Se 17th St Ocala FL 34471-4607 Ph: (352) 732-5590 | Ethos Health Melbourne Llc 2755 N Wickham Rd Ste 102 Melbourne FL 32935-2226 Ph: (352) 732-5590 |
| NPI Number | 1942792429 |
|---|---|
| Provider Enumeration Date | 05/31/2018 |
| Last Update Date | 05/06/2022 |
| Medicare PECOS PAC ID | 9234516485 |
|---|---|
| Medicare Enrollment ID | O20220510000809 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942792429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Michael A Ursillo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1992889745 PECOS PAC ID: 5496755498 Enrollment ID: I20091219000102 |
| Provider Name | Jennifer Lynn Waicus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417585316 PECOS PAC ID: 0547681785 Enrollment ID: I20200526003023 |
| Provider Name | Alyssa Marie Pamenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215276993 PECOS PAC ID: 7810375722 Enrollment ID: I20220606001983 |
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