HEALTHSTAT WELLNESS-POLK HAINES (NPI# 1134495245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134495245 |
| Entity Type | Organization |
| Organization Name | HEALTHSTAT WELLNESS-POLK HAINES |
| Other Organization Name | HEALTHSTAT ON-SITE CLINIC/POLK COUNTY |
| Practice Address |
631b Us Highway 17 92 W Haines City FL 33844-5047 |
| Mailing Address |
4601 Charlotte Park Dr Suite 390 Charlotte NC 28217-1915 |
| Practice Telephone | 8635193858 |
| Mailing Telephone | 7045296161 |
| Mailing Fax Number | 7049365570 |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2020-07-14 |
| Authorized Official Name | JILL JOHNSON PATTON (DIRECTOR OF RISK MANAGEMENT) |
| Authorized Official Telephone | 7049365546 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers | ||
| Y | 2083P0500X |
Preventive Medicine Specialization: Preventive Medicine/Occupational Environmental Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 5709730 | 01 |
| Other Name | Type Code |
|---|---|
| Healthstat On-Site Clinic/Polk County | Doing Business As Name - Organization |
| Street Address |
631B US HIGHWAY 17 92 W |
| City | HAINES CITY |
| State | FL |
| Zip Code | 33844-5047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134608342 | Patricia Vogl | Counselor | 360 S. 10th Street, Suite A, Haines City, FL 33844 | 2018-08-08 |
| 1639657257 | Jessica Herring | Physical Therapist | 35902 Us-27, Haines City, FL 33844 | 2018-08-06 |
| 1366896482 | Jovita Moise-brown | Custodial Care Facility | 2411 Dorado Ave, Haines City, FL 33844 | 2016-04-14 |
| 1730564170 | Maria Dolores Jimenez | Social Worker | 9024 Orange Blossom Loop, Haines City, FL 33844 | 2015-07-28 |
| 1346565819 | Elaine Carol Weinstein | Respiratory Therapist, Registered | 330 10th Street South, Haines City, FL 33844 | 2010-03-29 |
| 1194999813 | Janice Ramos Colon | General Practice | 502 E Hinson Ave, Haines City, FL 33844 | 2008-04-14 |
| 1225151913 | Erika Selga Grimes | Specialist/Technologist | 262 Paradise Island Dr, Haines City, FL 33844 | 2007-04-09 |
| 1912034265 | Xtra Discount Drugs Hc | Pharmacy | 401 East Hinson Ave, Haines City, FL 33844 | 2007-02-27 |
| 1689727562 | Sports and Orthopedic Rehabilitation Services Inc | Clinic/Center | 19 North 6th Street, Suite A, Haines City, FL 33844 | 2007-01-22 |
| 1194898841 | Jeffrey S Smith | Chiropractor | 101 S 10th Street, Haines City, FL 33844 | 2006-11-17 |
| Find all providers in zip 33844 | ||||
| Taxonomy Code | 2083P0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Preventive Medicine/Occupational Environmental Medicine |
| A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922606631 | Healthstat Wellness Health Center John Knox Village | Preventive Medicine | 500 South West 3rd Street, Suite 100, Pompano Beach, FL 33060 | 2020-10-14 |
| 1215588306 | Jmc Tallahassee, LLC | Preventive Medicine | 1838 Jacliff Court, Tallahassee, FL 32308 | 2019-09-20 |
| 1912463746 | Healthstat Wellness Pasco Land O Lakes | Preventive Medicine | 4111 Land O Lakes Blvd Ste 301, Land O Lakes, FL 34639-4403 | 2019-02-18 |
| 1811436884 | Healthstat Onsite Clinic Mosaic Highland Oaks | Preventive Medicine | 10210 Highland Manor Dr Ste 350, Tampa, FL 33610-9177 | 2017-02-23 |
| 1467902353 | Healthstat Onsite Clinic Mosaic South Pierce | Preventive Medicine | 7450 Hwy 630, Mulberry, FL 33860 | 2016-10-04 |
| 1427418003 | Healthstat Onsite Clinic Duette | Preventive Medicine | 1295 Duette Rd, Duette, FL 34219-7921 | 2016-02-25 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1588054514 | Healthstat Onsite Clinic Mosaic Plant City | Preventive Medicine | 10608 Paul Buchman Hwy, Plant City, FL 33565 | 2015-01-29 |
| 1356740757 | Healthstat Onsite Clinic- Mosaic Mulberry | Preventive Medicine | 3095 Highway 640 West, Mulberry, FL 33860 | 2014-08-21 |
| 1538568936 | Healthstat Onsite Clinic- Mosaic Bradley | Preventive Medicine | 11200 State Rd. 37 South, Bradley, FL 33835 | 2014-08-21 |
| Find all providers with the same taxonomy | ||||
| City | HAINES CITY |
| Zip Code | 33844 |
Please comment or provide details below to improve the information on HEALTHSTAT WELLNESS-POLK HAINES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.