1497856033 NPI number — COUNTY OF INDIAN RIVER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497856033 NPI number — COUNTY OF INDIAN RIVER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF INDIAN RIVER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INDIAN RIVER COUNTY DEPARTMENT OF EMERGENCY SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497856033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850001 DEPT 0669
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32885-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-226-3900
Provider Business Mailing Address Fax Number:
772-226-3868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4225 43RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32967-1671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-226-3900
Provider Business Practice Location Address Fax Number:
772-770-5147
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
772-226-3947

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  3101 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 088224100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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