1629027057 NPI number — STAT MEDICAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629027057 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:
1629027057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2008
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:
98021-7069
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:
3411 FRUITVALE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-3989
Provider Business Practice Location Address Fax Number:
509-972-4494
Provider Enumeration Date:
05/10/2006

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:  6012058040010003 , 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: 6012058040010003 , 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: 6012058040010003 , 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: 6012058040010003 , 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: ST2365 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0066134 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . 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".
  • Identifier: 9029265 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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