Healthcare Provider Details

I. General information

NPI: 1841245305
Provider Name (Legal Business Name): STAT DIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 TRINITY RD SUITE 104A
CORDOVA TN
38018-2723
US

IV. Provider business mailing address

2092 DALKEITH DR
GERMANTOWN TN
38139-3408
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-0878
  • Fax: 901-751-6574
Mailing address:
  • Phone: 901-756-0256
  • Fax: 901-624-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1454622
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier158385716
Identifier TypeMEDICAID
Identifier StateAR
Identifier Issuer

VIII. Authorized Official

Name: MRS. JOANN COHEN
Title or Position: PRESIDENT
Credential:
Phone: 901-756-0257