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General NPI Number Information
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NPI Number | 1184175861
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Entity Type | Organization
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Legal Business Name | INDIAN RIVER HEALTH SERVICES INC
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 1155 35TH LN 202
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City | VERO BEACH
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State | FL
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Zip | 32960-6521
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Country | US
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Telephone | 772-794-5800
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Fax | 772-794-1450
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Provider Business Mailing Address
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Address Line | PO BOX 830270 MSC 375
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City | BIRMINGHAM
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State | AL
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Zip | 35283-0270
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Country | US
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Telephone | 772-567-4311
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Fax | 772-794-1450
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Authorized Official
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Title or Position | CEO
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Name | MR. JEFFREY L SUSI
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Credential |
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Telephone | 772-567-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 4029
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License Number State | FL
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