Organization
HEALTHSTAT WELLNESS-POLK HAINES
Active
Other names
Healthstat On-Site Clinic/Polk County
Organization subpart
No
Provider details
NPI number
Authorized official
JILL JOHNSON PATTON (DIRECTOR OF RISK MANAGEMENT)
(704) 936-5546
Entity
Organization
Contact information
Practice address
631B US HIGHWAY 17 92 W, HAINES CITY, FL 33844-5047
(863) 519-3858
Mailing address
4601 CHARLOTTE PARK DR, SUITE 390, CHARLOTTE, NC 28217-1915
(704) 529-6161
(704) 936-5570
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5709730
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/23/2012
Last updated
07/14/2020
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