Provider Demographics
NPI:1699198556
Name:STATESERV MEDICAL, LLC
Entity Type:Organization
Organization Name:STATESERV MEDICAL, LLC
Other - Org Name:
Other - Org Type:
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:877-633-7250
Mailing Address - Fax:480-829-0057
Practice Address - Street 1:2940 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35907-7601
Practice Address - Country:US
Practice Address - Phone:877-633-7250
Practice Address - Fax:480-829-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies