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General NPI Number Information
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NPI Number | 1376864108
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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 | 06/16/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 3745 11TH CIRCLE SUITE 103
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City | VERO BEACH
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State | FL
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Zip | 32960
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Country | US
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Telephone | 772-794-9771
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Fax |
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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 |
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Authorized Official
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Title or Position | 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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME0067894
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License Number State | FL
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