SPACE COAST SURGICAL ASSISTING LLC NPI 1922404441

NPI Information

NPI: 1922404441
Provider Name: SPACE COAST SURGICAL ASSISTING LLC
Classification: Physician Assistant - 363AS0400X
Entity Type: Organization

Specialization: Surgical

CLIA Number: 10D2280177

Address:
749 MCDERMOTT AVE
MELBOURNE, FL
ZIP 32935
Phone: (321) 890-2022
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SPACE COAST SURGICAL ASSISTING LLC is a surgical physician assistant in Melbourne, FL. SPACE COAST SURGICAL ASSISTING LLC NPI is 1922404441. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

749 MCDERMOTT AVE
MELBOURNE, FL
ZIP 32935-038
Phone: (321) 890-2022

The provider's authorized official is Michael A Dancy .
The authorized official title is Mgr and has the following contact phone number (321) 890-2022.

The CLIA number assigned to this NPI record is 10D2280177 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/11/2014 and was last updated on 11/11/2014.

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	363AS0400X	Physician Assistant	Surgical			Yes

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: 4/28/2024

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