Provider Demographics
NPI:1730550328
Name:BREVARD CLINICAL RESEARCH CENTER, INC.
Entity type:Organization
Organization Name:BREVARD CLINICAL RESEARCH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-312-4530
Mailing Address - Street 1:4423 CYPRESS MILL RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:187 S WICKHAM RD
Practice Address - Street 2:UNIT 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1123
Practice Address - Country:US
Practice Address - Phone:321-312-4530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty