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Organization
INDIAN RIVER MEMORIAL HOSPITAL INC
Active
Organization
INDIAN RIVER MEMORIAL HOSPITAL INC
Active
Other names
Physician Billing
Organization subpart
No
Provider details
NPI number
Authorized official
TIM LONGVILLE (CHIEF ACCOUNTING OFFICER AND CONTRO)
(216) 636-7416
Entity
Organization
Contact information
Practice address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 567-4311
Mailing address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 567-4311
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4029
FL
2084P0800X
Psychiatry Physician
4029
FL
363L00000X
Nurse Practitioner
4029
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052555300
—
FL
01
—
98912
BLUE CROSS
FL
Enumeration date
03/21/2006
Last updated
02/23/2022
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