Provider Demographics
NPI:1801062310
Name:INDIAN RIVER MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:INDIAN RIVER MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP CHIEF FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LARAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-445-1343
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:STE 20 ATTN: DPC RK2-7
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5062
Mailing Address - Country:US
Mailing Address - Phone:216-636-4969
Mailing Address - Fax:
Practice Address - Street 1:1190 37TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6507
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIAN RIVER MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4029273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010104400Medicaid
FL309OtherBLUE CROSS
FL010104400Medicaid