Provider Demographics
NPI:1104600121
Name:STAT-ONE LLC
Entity type:Organization
Organization Name:STAT-ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LINDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-418-9187
Mailing Address - Street 1:409 E 500 S
Mailing Address - Street 2:
Mailing Address - City:CUTLER
Mailing Address - State:IN
Mailing Address - Zip Code:46920-9470
Mailing Address - Country:US
Mailing Address - Phone:765-480-7775
Mailing Address - Fax:
Practice Address - Street 1:409 E 500 S
Practice Address - Street 2:
Practice Address - City:CUTLER
Practice Address - State:IN
Practice Address - Zip Code:46920-9470
Practice Address - Country:US
Practice Address - Phone:765-480-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)