Healthcare Provider Details

I. General information

NPI: 1588011613
Provider Name (Legal Business Name): FIRST-STAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 ANDREA LN
FORT MYERS FL
33912-1986
US

IV. Provider business mailing address

2178 ANDREA LN
FORT MYERS FL
33912-1986
US

V. Phone/Fax

Practice location:
  • Phone: 239-215-9000
  • Fax: 239-215-9900
Mailing address:
  • Phone: 239-215-9000
  • Fax: 239-215-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number12345
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CLAYTON MCPETERS
Title or Position: MANAGER
Credential:
Phone: 239-215-9000