Organization
INDIAN RIVER MRI INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD COOPER M.D. (PRESIDENT/OWNER)
(772) 562-3030
Entity
Organization
Contact information
Practice address
1850 37TH ST, VERO BEACH, FL 32960-4856
(772) 562-3030
(772) 778-0766
Mailing address
1850 37TH ST, VERO BEACH, FL 32960-4856
(772) 562-3030
(772) 778-0766
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME45770
FL
291U00000X
Clinical Medical Laboratory
HCC5552
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V2952
BCBS PROVIDER NUMBER
FL
01
—
V2952
BCBS
—
Enumeration date
08/31/2006
Last updated
05/11/2010
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