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General NPI Number Information
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NPI Number | 1356689715
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Entity Type | Organization
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Legal Business Name | STAT MED SOLUTIONS PC INC
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Dates
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Enumeration Date | 01/19/2013
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Last Update Date | 01/19/2013
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Provider Practice Location Address
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Address Line | 1221 HIGHLAND AVE
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City | CLARKSTON
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State | WA
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Zip | 99403-2829
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Country | US
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Telephone | 509-758-5511
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17130
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City | RENO
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State | NV
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Zip | 89511-3103
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Country | US
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Telephone | 480-620-7181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAGJIT MANGAT
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Credential | MD
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Telephone | 480-620-7181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60249786
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License Number State | WA
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