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NPI Code Detail

MEDICARE: TREASURE COAST COMMUNITY HEALTH INC

MEDICARE: TREASURE COAST COMMUNITY HEALTH 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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

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

General Provider Information

NPI Number : 1912458613
Entity Type Code : Organization
Provider Name (Legal Business Name) : TREASURE COAST COMMUNITY HEALTH INC
Provider Business Mailing Address
First Line : 1555 INDIAN RIVER BLVD STE B210
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-7113
Country : US
Telephone Number : 772-257-8224
Fax Number : 772-252-3245
Provider Business Practice Location Address
First Line : 1545 9TH ST SW
Second Line :
City : VERO BEACH
State : FL
Zip : 32962-4312
Country : US
Telephone Number : 772-257-8224
Fax Number : 772-252-3245
Authorized Official
Title or Position : INTERIM CEO
Name : HEATHER MIRANDA
Credential :
Telephone Number : 772-257-8224
Provider Enumeration Date : 10/18/2016
Last Update Date : 02/06/2026

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1225024730 — DR. PRASAD R SIRIPURAPU MD
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1457349508 — KENNETH IAN JOHNSON MD
Practice Location Address:
1545 9TH ST SW
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1053386284 — DR. HEMANT P GUNDAVDA M.D.
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1841237260 — DR. YADIRA PADIN-ROJAS MD
Practice Location Address:
1545 9TH ST SW
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32962-4312
Practice Phone: 772-257-8224
Practice Fax: 772-213-3157

Directions to “TREASURE COAST COMMUNITY HEALTH INC ” Practice Location

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