Healthcare Provider Details

I. General information

NPI: 1104008507
Provider Name (Legal Business Name): MD-STAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S FLAMINGO RD #358
PEMBROKE PINES FL
33027-1770
US

IV. Provider business mailing address

320 S FLAMINGO RD #358
PEMBROKE PINES FL
33027-1770
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-6660
  • Fax: 954-436-6655
Mailing address:
  • Phone: 954-436-6660
  • Fax: 954-436-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONICA C SIMPSON
Title or Position: MEMBER/OWNER
Credential: ARNP
Phone: 954-436-6660