Healthcare Provider Details

I. General information

NPI: 1992083794
Provider Name (Legal Business Name): INDIAN RIVER HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 36TH ST SUITE 2105
VERO BEACH FL
32960-4862
US

IV. Provider business mailing address

1000 36TH ST
VERO BEACH FL
32960-4862
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-4311
  • Fax: 772-794-1450
Mailing address:
  • Phone: 772-567-4311
  • Fax: 772-794-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME78560
License Number StateFL

VIII. Authorized Official

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