Healthcare Provider Details

I. General information

NPI: 1093253221
Provider Name (Legal Business Name): STATESERV MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 AIRPORT ROAD UNIT F
SANTA FE NM
87507
US

IV. Provider business mailing address

1201 S. ALMA SCHOOL ROAD SUITE 4000
MESA AZ
85210
US

V. Phone/Fax

Practice location:
  • Phone: 480-966-9730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ROODE
Title or Position: COO
Credential:
Phone: 877-633-7250