Provider Demographics
NPI:1598835373
Name:HEALTH STATUS EVALUATIONS LLC
Entity Type:Organization
Organization Name:HEALTH STATUS EVALUATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BONFILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-744-7171
Mailing Address - Street 1:3801 N LIBERTY ST
Mailing Address - Street 2:SUITE 210 SMITH REYNOLDS AIRPORT TERMINAL
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-3968
Mailing Address - Country:US
Mailing Address - Phone:336-744-7171
Mailing Address - Fax:336-744-7182
Practice Address - Street 1:3801 N LIBERTY ST
Practice Address - Street 2:SUITE 210 SMITH REYNOLDS AIRPORT TERMINAL
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-3968
Practice Address - Country:US
Practice Address - Phone:336-744-7171
Practice Address - Fax:336-744-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93000412083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX850842Medicare UPIN