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INDIAN RIVER MEDICAL OFFICE PA NPI 1245220557


NPI Information

NPI: 1245220557
Provider Name: INDIAN RIVER MEDICAL OFFICE PA
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
3300 DAIRY RD
TITUSVILLE, FL
ZIP 32796
Phone: (321) 269-6530
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INDIAN RIVER MEDICAL OFFICE PA is a specialist in Titusville, FL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. INDIAN RIVER MEDICAL OFFICE PA NPI is 1245220557. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3300 DAIRY RD
TITUSVILLE, FL
ZIP 32796-512
Phone: (321) 269-6530
Fax: (321) 269-2334

The provider's authorized official is Jill D Whittamore .
The authorized official title is Administrator and has the following contact phone number (321) 267-6687.

The enumeration date for this NPI number is 10/27/2005 and was last updated on 3/3/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
140745OTHERFLORIDABCBS FL
2=========OTHERFLORIDATAX ID
340745MEDICARE PINFLORIDA
4250742100MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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