| Entity Name: | BREVARD MEDICAL EQUIPMENT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 13 Jun 1986 (39 years ago) |
| Document Number: | J19401 |
| FEI/EIN Number | 592692025 |
| Address: | 105 N BANANA RIVER DR., MERRITT ISLAND, FL, 32952 |
| Mail Address: | 105 N BANANA RIVER DR., MERRITT ISLAND, FL, 32952 |
| ZIP code: | 32952 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457351231 | 2005-07-22 | 2008-09-30 | 105 N BANANA RIVER DR, MERRITT ISLAND, FL, 329522546, US | 105 N BANANA RIVER DR, MERRITT ISLAND, FL, 329522546, US | |||||||||||||||||||||||
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| Phone | +1 321-453-3370 |
Authorized person
| Name | GREG P BONENBERGER |
| Role | VICE-PRESIDENT |
| Phone | 3214533370 |
Taxonomy
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| License Number | 1312632 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 030894300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOBBS, SIDNEY MARK | Agent | 585 River Moorings Dr, MERRITT ISLAND, FL, 32953 |
| Name | Role | Address |
|---|---|---|
| Ray David C | Director | 1407 ROCKLEDGE DR., ROCKLEDGE, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| BONENBERGER GREG | Treasurer | 2135 N. Courtenay Pkwy, MERRITT ISLAND, FL, 32953 |
| Name | Role | Address |
|---|---|---|
| HOBBS, SIDNEY MARK | President | 585 river moorings dr, MERRITT ISLAND, FL, 32953 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
