Provider Demographics
NPI:1811519234
Name:INSTIC HEALTH LLC
Entity type:Organization
Organization Name:INSTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDDHARTH
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-755-7300
Mailing Address - Street 1:105 N ALEXANDER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4831
Mailing Address - Country:US
Mailing Address - Phone:813-755-7300
Mailing Address - Fax:
Practice Address - Street 1:105 N ALEXANDER ST STE 105
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4831
Practice Address - Country:US
Practice Address - Phone:813-755-7300
Practice Address - Fax:833-905-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111280000Medicaid