| Indian River Mri Inc | |
|
1850 37th St Vero Beach FL 32960-4856 | |
| (772) 562-3030 | |
| (772) 778-0766 |
| Full Name | Indian River Mri Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1850 37th St, Vero Beach, Florida |
| Authorized Official Name and Position | Ronald Cooper (PRESIDENT/OWNER) |
| Authorized Official Contact | 7725623030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian River Mri Inc 1850 37th St Vero Beach FL 32960-4856 Ph: (772) 562-3030 | Indian River Mri Inc 1850 37th St Vero Beach FL 32960-4856 Ph: (772) 562-3030 |
| NPI Number | 1215049614 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 05/11/2010 |
| Medicare PECOS PAC ID | 0446248363 |
|---|---|
| Medicare Enrollment ID | O20141220000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215049614 | NPI | - | NPPES |
| V2952 | Other | BCBS | |
| V2952 | Other | FL | BCBS PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | ME45770 (Florida) | Primary |
| 291U00000X | Clinical Medical Laboratory | HCC5552 (Florida) | Secondary |
| Provider Name | John J Holmes |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043211576 PECOS PAC ID: 3072414184 Enrollment ID: I20040120000624 |
| Provider Name | Jeffrey B Sacks |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962403188 PECOS PAC ID: 4486556156 Enrollment ID: I20040122001186 |
| Provider Name | George T Puskar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1386641868 PECOS PAC ID: 0749277002 Enrollment ID: I20040428000935 |
| Provider Name | Ronald Cooper |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306885694 PECOS PAC ID: 6800859521 Enrollment ID: I20041104000396 |
| Provider Name | Harry K Meisenbach |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619923984 PECOS PAC ID: 3274536727 Enrollment ID: I20060823000078 |
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