1568412435 NPI number — STAT MEDICAL INC

Table of content: (NPI 1568412435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568412435 NPI number — STAT MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAT MEDICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568412435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21222 30TH DR SE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98021-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-621-1982
Provider Business Mailing Address Fax Number:
425-820-0831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
732 LEBO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-792-2695
Provider Business Practice Location Address Fax Number:
360-792-2697
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONFORTO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
206-621-1982

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  6012058040010007 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 6012058040010007 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X , with the licence number: 6012058040010007 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 6012058040010007 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9029265 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9047085 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ST2365 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9038860 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0066134 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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