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General NPI Number Information
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NPI Number | 1942674593
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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 | 11/19/2015
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 801 WELLNESS WAY SUITE 109
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City | SEBASTIAN
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State | FL
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Zip | 32958-3783
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Country | US
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Telephone | 772-794-5611
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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 | 772-794-5611
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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