Provider Demographics
NPI:1104008507
Name:MD-STAT LLC
Entity Type:Organization
Organization Name:MD-STAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-436-6660
Mailing Address - Street 1:320 S FLAMINGO RD
Mailing Address - Street 2:#358
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1770
Mailing Address - Country:US
Mailing Address - Phone:954-436-6660
Mailing Address - Fax:954-436-6655
Practice Address - Street 1:320 S FLAMINGO RD
Practice Address - Street 2:#358
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1770
Practice Address - Country:US
Practice Address - Phone:954-436-6660
Practice Address - Fax:954-436-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty