PARRISH MEDICAL GROUP (NORTH BREVARD MEDICAL SUPPORT, INC) NPI 1609834886

Clinic/Center (Multi-Specialty) in Titusville, FL

NPI 1609834886 Organization Clinic/Center Multi-Specialty CLIA Number 10D2164158 CLIA Certificate of Waiver

About PARRISH MEDICAL GROUP (NORTH BREVARD MEDICAL SUPPORT, INC)

Parrish Medical Group (north Brevard Medical Support, Inc) is a provider established in Titusville, Florida specializing in clinic/center (multi-specialty) . The NPI number of Parrish Medical Group (north Brevard Medical Support, Inc) is 1609834886 and was assigned on May 2006. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The provider's is doing business as Parrish Medical Group. The authorized official of this NPI record is Mr. Kent Bailey (Vp Finance)

The CLIA number of Parrish Medical Group is 10D2164158 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Parrish Medical Group to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1609834886

Provider NamePARRISH MEDICAL GROUP (NORTH BREVARD MEDICAL SUPPORT, INC)
Provider Location Address250 HARRISON ST TITUSVILLE, FL 32780
Provider Mailing Address951 N WASHINGTON AVE TITUSVILLE, FL 32796
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NamePARRISH MEDICAL GROUP
Other Name TypeDoing Business As (3)
Enumeration Date05-03-2006
Last Update Date03-25-2020


Primary Taxonomy

Taxonomy Code261QM1300X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationMulti-Specialty

Business Address

PARRISH MEDICAL GROUP
250 HARRISON ST
TITUSVILLE, FL
ZIP 32780
Phone: (321) 268-6868
Fax: (321) 267-2713

Get Directions


Mailing Address

PARRISH MEDICAL GROUP
951 N WASHINGTON AVE
TITUSVILLE, FL
ZIP 32796
Phone: (321) 268-6834
Fax: (321) 268-0125



Secondary Locations

390 Challenger Rd
Cape Canaveral, FL 32920
(321) 633-8640
5005 Port St John Pkwy
Port St John, FL 32927
(321) 504-0556
494 N Washington Ave
Titusville, FL 32796
(321) 267-8311
951 N Washington Ave
Titusville, FL 32796
(321) 268-6834

Authorized Official

Authorized Official NameMR. KENT BAILEY
Authorized Official TitleVP FINANCE
Authorized Official Phone(321) 268-6111

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1609834886 is:

CLIA Number10D2164158
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
265539009MEDICAID (05)FL
265539000MEDICAID (05)FL

Other Providers at the same location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1063685774MS. CARA E STARKEY CNM, ARNP
Individual
Advanced Practice Midwife250 HARRISON ST
TITUSVILLE, FL 32780
(321) 268-6868
1790733426 MANUEL ANGEL NAVAS MICHEO M.D., F.A.C.O.G.
Individual
Obstetrics & Gynecology250 HARRISON ST
TITUSVILLE, FL 32780
(321) 268-6868
1619979853DR. RICHARD KRUBEL MD
Individual
Family Medicine250 HARRISON ST
TITUSVILLE, FL 32780
(321) 268-6868
1902855596DR. ETHAN ALAN WEBB M.D.
Individual
Internal Medicine250 HARRISON ST
TITUSVILLE, FL 32780
(321) 267-1424
1164751095DR. RHU-JADE M RAGUINDIN M.D.
Individual
Internal Medicine250 HARRISON ST
TITUSVILLE, FL 32780
(321) 267-1424
1962851006WOODFORD DIALYSIS, LLC
Organization
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)250 HARRISON ST STE 110
TITUSVILLE, FL 32780
(321) 383-1345
1801145826DR. MADONNA HANNA M.D.
Individual
Family Medicine250 HARRISON ST
TITUSVILLE, FL 32780
(321) 268-6868

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The 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 Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type 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 (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.