Provider Demographics
NPI:1780951897
Name:HEALTHSTAT ON-SITE CLINIC
Entity type:Organization
Organization Name:HEALTHSTAT ON-SITE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/EVP MARKETING/SALES
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-529-6161
Mailing Address - Street 1:4601 CHARLOTTE PARK DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1915
Mailing Address - Country:US
Mailing Address - Phone:704-529-6161
Mailing Address - Fax:704-936-5570
Practice Address - Street 1:10427 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3428
Practice Address - Country:US
Practice Address - Phone:865-218-4430
Practice Address - Fax:865-218-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty