Provider Demographics
NPI:1841010816
Name:INDIAN RIVER MEDICAL CENTER LLC
Entity type:Organization
Organization Name:INDIAN RIVER MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KOVATS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-920-0932
Mailing Address - Street 1:2568 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-5980
Mailing Address - Country:US
Mailing Address - Phone:208-920-0932
Mailing Address - Fax:
Practice Address - Street 1:3821 WOODBRIAR TRL STE 6
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-9611
Practice Address - Country:US
Practice Address - Phone:386-333-6158
Practice Address - Fax:386-333-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1376042134OtherAPRN