Provider Demographics
NPI:1629027057
Name:STAT MEDICAL INC
Entity Type:Organization
Organization Name:STAT MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CONFORTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-621-1982
Mailing Address - Street 1:21222 30TH DR SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7069
Mailing Address - Country:US
Mailing Address - Phone:206-621-1982
Mailing Address - Fax:425-820-0831
Practice Address - Street 1:3411 FRUITVALE BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7320
Practice Address - Country:US
Practice Address - Phone:509-972-3989
Practice Address - Fax:509-972-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6012058040010003332B00000X, 332BC3200X, 332BN1400X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAST2365OtherREGENCE BLUE SHIELD
WA0066134OtherLABOR & INDUSTRIES
WA9047085Medicaid
WA9038860Medicaid
WA9029265Medicaid
WA9047085Medicaid