Provider Demographics
NPI:1821242389
Name:MEDASTAT USA
Entity Type:Organization
Organization Name:MEDASTAT USA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGULATORY COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-489-9449
Mailing Address - Street 1:1920 STANLEY GAULT PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4208
Mailing Address - Country:US
Mailing Address - Phone:502-489-9449
Mailing Address - Fax:502-489-9401
Practice Address - Street 1:206 JACOBS RUN
Practice Address - Street 2:STE A
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8907
Practice Address - Country:US
Practice Address - Phone:888-750-7828
Practice Address - Fax:866-750-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3222775-001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies