Provider Demographics
NPI:1861675654
Name:STATMED QUICK QUALITY CLINIC AT NORTH PINELLAS LLC
Entity type:Organization
Organization Name:STATMED QUICK QUALITY CLINIC AT NORTH PINELLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:727-726-1962
Mailing Address - Street 1:27001 US HIGHWAY 19 N STE 1033B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3407
Mailing Address - Country:US
Mailing Address - Phone:727-726-1962
Mailing Address - Fax:727-726-1606
Practice Address - Street 1:27001 US HIGHWAY 19 N STE 1033B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3407
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:2007-12-14
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101634363AM0700X
FLME0083573207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6200390001Medicare NSC