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1190 37th St Vero Beach FL 32960-6507 | |
| (772) 567-4311 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1190 37th St, Vero Beach, Florida |
| Authorized Official Name and Position | Timothy L. Longville (CHIEF ACCOUNTING OFFICER/CONTROLLER) |
| Authorized Official Contact | 2166367416 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1000 36th St Vero Beach FL 32960-4862 Ph: (772) 567-4311 | 1190 37th St Vero Beach FL 32960-6507 Ph: (772) 567-4311 |
| NPI Number | 1801062310 |
|---|---|
| Provider Enumeration Date | 05/05/2008 |
| Last Update Date | 09/05/2024 |
| Certification Date | 09/05/2024 |
| Medicare PECOS PAC ID | 2365332632 |
|---|---|
| Medicare Enrollment ID | O20120604000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801062310 | NPI | - | NPPES |
| 010104400 | Medicaid | FL | |
| 309 | Other | FL | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 4029 (Florida) | Primary |
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