Provider Demographics
NPI:1912208505
Name:INDIAN RIVER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:INDIAN RIVER HEALTH SERVICES INC
Other - Org Name:IRMC PHYSICIAN NETWORK-GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-567-4311
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-794-1450
Practice Address - Street 1:1040 37TH PL
Practice Address - Street 2:SUITE 200
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4806
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:772-794-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA009Medicare PIN