1528272861 NPI number — INDIAN RIVER HAND REHABILITATION INC

Table of content: DR. HARRY EDWARD GOHN III D.M.D (NPI 1588958060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528272861 NPI number — INDIAN RIVER HAND REHABILITATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIAN RIVER HAND REHABILITATION INC
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 HAND REHAB
Provider Other Organization Name Type Code:
3
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:
1528272861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
787 37TH ST
Provider Second Line Business Mailing Address:
SUITE E-110
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-7305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-562-6401
Provider Business Mailing Address Fax Number:
772-562-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
787 37TH ST
Provider Second Line Business Practice Location Address:
SUITE E-110
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-562-6401
Provider Business Practice Location Address Fax Number:
772-562-6011
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEARD
Authorized Official First Name:
STACY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
772-562-6401

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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