Provider Demographics
NPI:1881085918
Name:STAT.MD, LLC
Entity type:Organization
Organization Name:STAT.MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:NICKEY
Authorized Official - Last Name:GORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-756-3008
Mailing Address - Street 1:1209 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463-9266
Mailing Address - Country:US
Mailing Address - Phone:910-840-9559
Mailing Address - Fax:
Practice Address - Street 1:3993 MEETING STREET
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-3053
Practice Address - Country:US
Practice Address - Phone:843-756-3008
Practice Address - Fax:843-756-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty