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1402 Oak St Melbourne FL 32901-3113 | |
(321) 427-3089 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 1402 Oak St, Melbourne, Florida |
Authorized Official Name and Position | Derrick Levasca Jenkins (PRESIDENT) |
Authorized Official Contact | 3216370852 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 560914 Rockledge FL 32956-0914 Ph: (321) 427-3089 | 1402 Oak St Melbourne FL 32901-3113 Ph: (321) 427-3089 |
NPI Number | 1417087495 |
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Provider Enumeration Date | 03/07/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1417087495 | NPI | - | NPPES |
HCC6819 | Other | FL | HEALTH CARE CLINIC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | HCC6819 (Florida) | Primary |
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