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General NPI Number Information
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NPI Number | 1841010816
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Entity Type | Organization
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Legal Business Name | INDIAN RIVER MEDICAL CENTER LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 3821 WOODBRIAR TRL STE 6
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City | PORT ORANGE
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State | FL
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Zip | 32129-9611
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Country | US
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Telephone | 386-333-6158
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Fax | 386-333-6158
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Provider Business Mailing Address
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Address Line | 2568 S RIDGEWOOD AVE
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City | EDGEWATER
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State | FL
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Zip | 32141-5980
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Country | US
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Telephone | 208-920-0932
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTIAN ANDREW KOVATS
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Credential | DO
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Telephone | 208-920-0932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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