1548454929 NPI number — STAT MEDICAL, INC

Table of content: (NPI 1548454929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548454929 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:
1548454929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
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:
98021-7019
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:
14031 NE WOODINVILLE DUVALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODINVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98072-8504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-621-1982
Provider Business Practice Location Address Fax Number:
425-481-8365
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCDERMOTT
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ANGELA
Authorized Official Title or Position:
CUSTOMER ACCOUNTS MANAGER
Authorized Official Telephone Number:
425-216-3933

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

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




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