Provider Demographics
NPI:1902279300
Name:INDIAN RIVER SURGERY CENTER, LTD.
Entity Type:Organization
Organization Name:INDIAN RIVER SURGERY CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:1325 36TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 36TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6599
Practice Address - Country:US
Practice Address - Phone:205-545-2572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical