Healthcare Provider Details

I. General information

NPI: 1720194160
Provider Name (Legal Business Name): INDIAN RIVER HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 37TH PL SUITE 101
VERO BEACH FL
32960-4806
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 772-563-4580
  • Fax: 772-563-4690
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY L SUSI
Title or Position: CEO
Credential:
Phone: 772-567-4311