Provider Demographics
NPI:1245456169
Name:STAT MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:STAT MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERENGUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-756-9466
Mailing Address - Street 1:9526 NE 2ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2750
Mailing Address - Country:US
Mailing Address - Phone:305-756-9466
Mailing Address - Fax:
Practice Address - Street 1:9526 NE 2ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2750
Practice Address - Country:US
Practice Address - Phone:305-756-9466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88240208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL207707100Medicaid
FLI14642Medicare UPIN