Basic Information
| Provider Information | |||||||||
| NPI: | 1740226638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | E R STAT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 918972 | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328918972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004433672 | ||||||||
| FaxNumber: | 8656507310 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331462008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3066693469 | ||||||||
| FaxNumber: | 7863083902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | PORTUONDO | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3056693469 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 254767800 | 05 | FL | MEDICAID |