Provider Demographics
NPI:1023681343
Name:CANCER CARE CENTERS OF BREVARD INC
Entity type:Organization
Organization Name:CANCER CARE CENTERS OF BREVARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:ERENTREICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-636-2111
Mailing Address - Street 1:1430 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3119
Mailing Address - Country:US
Mailing Address - Phone:321-952-0898
Mailing Address - Fax:321-722-1342
Practice Address - Street 1:240 N WICKHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8663
Practice Address - Country:US
Practice Address - Phone:321-752-4811
Practice Address - Fax:321-752-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty