Provider Demographics
NPI:1417954355
Name:AUSTIN STAATS MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:AUSTIN STAATS MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-385-8541
Mailing Address - Street 1:5105 GLENDALE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1850
Mailing Address - Country:US
Mailing Address - Phone:419-385-8547
Mailing Address - Fax:419-385-8543
Practice Address - Street 1:5105 GLENDALE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1850
Practice Address - Country:US
Practice Address - Phone:419-385-8547
Practice Address - Fax:419-385-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2302618Medicaid
MI4351990Medicaid
OH2302618Medicaid