MEDICARE: STAT MEDICAL CLINIC IV INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1487884540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAT MEDICAL CLINIC IV INC

Provider Business Mailing Address
First Line	:	2535 E SUNRISE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3203
Country	:	US
Telephone Number	:	954-568-1818
Fax Number	:	954-568-1475

Provider Business Practice Location Address
First Line	:	2535 E SUNRISE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3203
Country	:	US
Telephone Number	:	954-568-1818
Fax Number	:	954-568-1475

Authorized Official
Title or Position	:	BILLING/CODING
Name	:	PATRICE PRYCE
Credential	:
Telephone Number	:	954-568-1818

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/22/2009

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