MEDICARE: INDIAN RIVER HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578833315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIAN RIVER HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	1000 36TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4862
Country	:	US
Telephone Number	:	772-567-4311
Fax Number	:	772-563-4723

Provider Business Practice Location Address
First Line	:	937 BAREFOOT BLVD
Second Line	:
City	:	BAREFOOT BAY
State	:	FL
Zip	:	32976-7654
Country	:	US
Telephone Number	:	772-664-4349
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JEFFREY L SUSI
Credential	:
Telephone Number	:	772-567-4311

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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Directions to “INDIAN RIVER HEALTH SERVICES INC ” Practice Location

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