=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548454929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAT MEDICAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2007
-----------------------------------------------------
Last Update Date | 07/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14031 NE WOODINVILLE DUVALL RD
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-8504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-621-1982
-----------------------------------------------------
Fax | 425-481-8365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21222 30TH DR SE SUITE 210
-----------------------------------------------------
City | BOTHELL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98021-7019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-621-1982
-----------------------------------------------------
Fax | 425-820-0831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CUSTOMER ACCOUNTS MANAGER
-----------------------------------------------------
Name | MARY ANGELA MCDERMOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-216-3933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------