Organization
INDIAN RIVER MEDICAL OFFICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL D WHITTAMORE CMM CPC (ADMINISTRATOR)
(321) 267-6687
Entity
Organization
Contact information
Practice address
3300 DAIRY RD, TITUSVILLE, FL 32796-1512
(321) 269-6530
(321) 269-2334
Mailing address
3300 DAIRY RD, TITUSVILLE, FL 32796-1512
(321) 269-6530
(321) 269-2334
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250742100
—
FL
01
—
40745
BCBS FL
FL
Enumeration date
10/27/2005
Last updated
03/03/2011
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