SPACE COAST DERMATOLOGY CLINIC PLLC NPI 1043423189

NPI Information

NPI: 1043423189
Provider Name: SPACE COAST DERMATOLOGY CLINIC, PLLC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address: 695 CONE PARK CT
MERRITT ISLAND, FL
ZIP 32952
Phone: (321) 453-3360

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NPI Details

SPACE COAST DERMATOLOGY CLINIC, PLLC is a clinic center in Merritt Island, FL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). SPACE COAST DERMATOLOGY CLINIC, PLLC NPI is 1043423189. The provider is registered as an organization entity type.

The provider's business location address is:

695 CONE PARK CT
MERRITT ISLAND, FL
ZIP 32952-755
Phone: (321) 453-3360
Fax: (321) 453-4586

The provider's authorized official is James A Earhart .
The authorized official title is Partner and has the following contact phone number (321) 453-3360.

The enumeration date for this NPI number is 5/7/2007 and was last updated on 11/18/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00844	MEDICARE ID-TYPE UNSPECIFIED	FLORIDA	SPACE COAST DERMATOLOGY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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