Provider Demographics
NPI:1841245305
Name:STAT DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:STAT DIAGNOSTICS, INC.
Other - Org Name:NEWGEN ADVANCED ORTHOTICS LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-756-0257
Mailing Address - Street 1:2092 DALKEITH DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3408
Mailing Address - Country:US
Mailing Address - Phone:901-756-0256
Mailing Address - Fax:901-624-2073
Practice Address - Street 1:7730 TRINITY RD
Practice Address - Street 2:SUITE 104A
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2723
Practice Address - Country:US
Practice Address - Phone:901-757-0878
Practice Address - Fax:901-751-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454622Medicaid
AR158385716Medicaid
AR158385716Medicaid