Healthcare Provider Details

I. General information

NPI: 1134178866
Provider Name (Legal Business Name): STAT MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20038 68TH AVE S SUITE 101
KENT WA
98032-2154
US

IV. Provider business mailing address

21222 30TH DR SE SUITE 210
BOTHELL WA
98021-7069
US

V. Phone/Fax

Practice location:
  • Phone: 253-395-2630
  • Fax: 253-395-2634
Mailing address:
  • Phone: 206-621-1982
  • Fax: 425-820-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number601205804110
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number601205804110
License Number StateWA

VIII. Authorized Official

Name: MICHAEL ANTHONY CONFORTO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 206-621-1982