Provider Demographics
NPI:1467712695
Name:INDIAN RIVER VOLUNTEERS IN MEDICINE
Entity Type:Organization
Organization Name:INDIAN RIVER VOLUNTEERS IN MEDICINE
Other - Org Name:SPACE COAST VOLUNTEERS IN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STOECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-639-5813
Mailing Address - Street 1:2555 JUDGE FRAN JAMIESON WAY
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-5998
Mailing Address - Country:US
Mailing Address - Phone:321-639-5813
Mailing Address - Fax:321-637-7512
Practice Address - Street 1:2555 JUDGE FRAN JAMIESON WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-5998
Practice Address - Country:US
Practice Address - Phone:321-639-5813
Practice Address - Fax:321-637-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty