Provider Demographics
NPI:1134423072
Name:PST FLORIDA 2009 LLC
Entity type:Organization
Organization Name:PST FLORIDA 2009 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISCHKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-896-9301
Mailing Address - Street 1:3300 SW 34TH AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7448
Mailing Address - Country:US
Mailing Address - Phone:877-896-9301
Mailing Address - Fax:
Practice Address - Street 1:3300 SW 34TH AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7448
Practice Address - Country:US
Practice Address - Phone:877-896-9301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty