Provider Demographics
NPI:1053831644
Name:BORCK, RICHARD (BS, EMT-B)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:BORCK
Suffix:
Gender:M
Credentials:BS, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3113
Mailing Address - Country:US
Mailing Address - Phone:321-722-3288
Mailing Address - Fax:321-722-3468
Practice Address - Street 1:1402 OAK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3113
Practice Address - Country:US
Practice Address - Phone:321-722-3288
Practice Address - Fax:321-722-3468
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246W00000X, 246XS1301X
FL510263146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty