Provider Demographics
NPI:1649502170
Name:STATMED QUICK QUALITYCLINC AT NORTH PINELLASLLC
Entity type:Organization
Organization Name:STATMED QUICK QUALITYCLINC AT NORTH PINELLASLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:WEBSTER
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-726-1962
Mailing Address - Street 1:2560 N MCMULLEN BOOTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4182
Mailing Address - Country:US
Mailing Address - Phone:727-726-1962
Mailing Address - Fax:727-726-1606
Practice Address - Street 1:2560 N MCMULLEN BOOTH RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4182
Practice Address - Country:US
Practice Address - Phone:727-726-1962
Practice Address - Fax:727-726-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL09190534261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care