Indian River Memorial Hospital Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4029 Issued in FL

Legal business name

INDIAN RIVER MEMORIAL HOSPITAL INC

Practice address

1000 36TH St
Vero Beach, FL 32960-4862

Phone

(772) 567-4311

NPI assigned

Mar 21, 2006

Last updated

Feb 23, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tim Longville

Title

Chief Accounting Officer and Contro

Phone

(216) 636-7416

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Physician Billing Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1497714380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 36TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604862",
            "telephone_number": "772-567-4311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 36TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604862",
            "telephone_number": "772-567-4311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN RIVER MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A",
        "authorized_official_last_name": "LONGVILLE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER AND CONTRO",
        "authorized_official_telephone_number": "216-636-7416"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "4029",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "4029",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "4029",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "052555300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "98912",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physician Billing",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Physician Billing",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Internal Medicine Physician in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.