Organization
INDIAN RIVER ASSISTING SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRENT SMITH BRISTER PA (PRESIDENT)
(772) 713-7231
Entity
Organization
Contact information
Practice address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 713-7231
Mailing address
PO BOX 643264, VERO BEACH, FL 32964-3264
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA3641
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD8238
RAILROAD
FL
Enumeration date
12/04/2006
Last updated
10/04/2007
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