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General NPI Number Information
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NPI Number | 1184902983
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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 | 07/27/2011
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 1000 36TH ST SUITE 6094
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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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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Provider Business Mailing Address
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Address Line | 1000 36TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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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 | PRESIDENT/CEO
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Name | 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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | OSW0004593
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License Number State | FL
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