Provider Demographics
NPI:1376739458
Name:STATESERV MEDICAL, LLC
Entity Type:Organization
Organization Name:STATESERV MEDICAL, LLC
Other - Org Name:STATESERV MEDICAL LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-633-7250
Mailing Address - Street 1:1201 S. ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:877-797-8061
Mailing Address - Fax:336-227-3288
Practice Address - Street 1:6800 NORTH CARMINO MARTIN
Practice Address - Street 2:SUITE 106 & 112
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:480-797-8061
Practice Address - Fax:866-280-0415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE STATESERV COMPANIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5619060002Medicare NSC