Provider Demographics
NPI:1568623858
Name:STAMEN MEDICAL SYSTEMS, LLC
Entity Type:Organization
Organization Name:STAMEN MEDICAL SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TESTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-863-7100
Mailing Address - Street 1:4806 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2605
Mailing Address - Country:US
Mailing Address - Phone:706-863-7100
Mailing Address - Fax:706-863-8882
Practice Address - Street 1:4806 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2605
Practice Address - Country:US
Practice Address - Phone:706-863-7100
Practice Address - Fax:706-863-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6185430001Medicare NSC