Provider Demographics
NPI:1588011613
Name:FIRST-STAT, LLC
Entity Type:Organization
Organization Name:FIRST-STAT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:MCPETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-215-9000
Mailing Address - Street 1:2178 ANDREA LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1986
Mailing Address - Country:US
Mailing Address - Phone:239-215-9000
Mailing Address - Fax:239-215-9900
Practice Address - Street 1:2178 ANDREA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1986
Practice Address - Country:US
Practice Address - Phone:239-215-9000
Practice Address - Fax:239-215-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12345332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies