Healthcare Provider Details

I. General information

NPI: 1700118007
Provider Name (Legal Business Name): STATMED QUICK QUALITY OF NORTH PINELLAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 W BAY DR
LARGO FL
33770-3248
US

IV. Provider business mailing address

27001 US HIGHWAY 19 N STE 1033B
CLEARWATER FL
33761-3407
US

V. Phone/Fax

Practice location:
  • Phone: 727-386-4114
  • Fax: 727-386-4115
Mailing address:
  • Phone: 727-726-1962
  • Fax: 727-726-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0083573
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101634
License Number StateFL

VIII. Authorized Official

Name: MARK MULLER
Title or Position: PRESIDENT
Credential: PA-C
Phone: 727-726-1962