Provider Demographics
NPI:1093560534
Name:STATUS HEALTH, PA
Entity Type:Organization
Organization Name:STATUS HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURROGATE/POA
Authorized Official - Prefix:
Authorized Official - First Name:RODELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:954-281-9631
Mailing Address - Street 1:7901 4TH ST N # 15980
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:954-281-9631
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N # 15980
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:954-281-9631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center