Healthcare Provider Details

I. General information

NPI: 1528592433
Provider Name (Legal Business Name): STEWARD SEBASTIAN RIVER MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13695 US HIGHWAY 1
SEBASTIAN FL
32958-3230
US

IV. Provider business mailing address

1900 N PEARL ST STE 2400
DALLAS TX
75201-2470
US

V. Phone/Fax

Practice location:
  • Phone: 772-589-3186
  • Fax:
Mailing address:
  • Phone: 469-341-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4375
License Number StateFL

VIII. Authorized Official

Name: JOHN DOYLE
Title or Position: CFO
Credential:
Phone: 469-341-8804