=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053178384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDIAN RIVER HEARING CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2024
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 491 22ND PL
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-6002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-978-9880
-----------------------------------------------------
Fax | 772-365-3965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 491 22ND PL
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-6002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-978-9880
-----------------------------------------------------
Fax | 772-365-3965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KEVIN MCCURDY
-----------------------------------------------------
Credential | H.A.S.
-----------------------------------------------------
Telephone | 772-978-9880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------