Provider Demographics
NPI:1215238803
Name:STAT DME LLC
Entity type:Organization
Organization Name:STAT DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-573-5600
Mailing Address - Street 1:2001 E SABINE ST
Mailing Address - Street 2:STE 104
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5644
Mailing Address - Country:US
Mailing Address - Phone:361-573-5600
Mailing Address - Fax:361-573-5601
Practice Address - Street 1:2001 E SABINE ST
Practice Address - Street 2:STE 104
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5644
Practice Address - Country:US
Practice Address - Phone:361-573-5600
Practice Address - Fax:361-573-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6483680001Medicare NSC