Healthcare Provider Details

I. General information

NPI: 1063607539
Provider Name (Legal Business Name): ST. ANNE MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 FOREST HILL BLVD STE G
LAKE CLARKE SHORES FL
33406-6073
US

IV. Provider business mailing address

1495 FOREST HILL BLVD STE G
LAKE CLARKE SHORES FL
33406-6073
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-0009
  • Fax: 561-965-0432
Mailing address:
  • Phone: 561-965-0009
  • Fax: 561-965-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberHCC6022
License Number StateFL

VIII. Authorized Official

Name: JANNA MARIA STORINO
Title or Position: PRESIDENT
Credential: AP
Phone: 561-965-0009