Provider Demographics
NPI:1982107728
Name:STAT MEDICAL LLC
Entity Type:Organization
Organization Name:STAT MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:THORNTON
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-263-9433
Mailing Address - Street 1:60 E TOWNSHIP ST STE 5
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2836
Mailing Address - Country:US
Mailing Address - Phone:877-521-5510
Mailing Address - Fax:866-403-2361
Practice Address - Street 1:60 E TOWNSHIP ST STE 5
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2836
Practice Address - Country:US
Practice Address - Phone:877-521-5510
Practice Address - Fax:866-403-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies