Healthcare Provider Details

I. General information

NPI: 1790011344
Provider Name (Legal Business Name): STAT MEDICAL SUPPLY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 WESTBURY CIR
NORTH AURORA IL
60542-1755
US

IV. Provider business mailing address

1510 WESTBURY CIR
NORTH AURORA IL
60542-1755
US

V. Phone/Fax

Practice location:
  • Phone: 630-709-3121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL MINALTOSKI
Title or Position: PRESIDENT
Credential:
Phone: 630-709-3121