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  7. NPI Record 1225702962

NORTH BREVARD MEDICAL SUPPORT, INC
Complete NPI Record 1225702962
Physical Medicine & Rehabilitation in Cape Canaveral, FL

NPI Status: Active since August 05, 2021

Contact Information

390 CHALLENGER RD
CAPE CANAVERAL, FL
ZIP 32920
Phone: (321) 633-8640
Fax: (321) 633-8645

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Middle Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Healthcare Provider Taxonomy Code 2
  29. Healthcare Provider Primary Taxonomy Switch 2
  30. Is Organization Subpart
  31. Healthcare Provider Taxonomy Group 1
  32. Healthcare Provider Taxonomy Group 2
  33. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1225702962. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1225702962
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 805 CENTURY MEDICAL DR STE C
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: TITUSVILLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: FL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 327962100
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3212686264
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3212686273
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 390 CHALLENGER RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: CAPE CANAVERAL
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 329204200
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3216338640
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3216338645
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/5/2021
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/5/2021
The date that a record was last updated or changed.
Authorized Official Last Name: BAILEY
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: KENT
The first name of the authorized official.
Authorized Official Middle Name: ANDREW
The middle name of the authorized official.
Authorized Official Title or Position: VP FINANCE
The title or position of the authorized official.
Authorized Official Telephone Number: 3212686111
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 225100000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 208100000X
Healthcare Provider Primary Taxonomy Switch 2: Y
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 8/5/2021