Provider Demographics
NPI:1851981757
Name:VASCULAR ACCESS STAT, LLC
Entity type:Organization
Organization Name:VASCULAR ACCESS STAT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:OUMA
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:586-460-9625
Mailing Address - Street 1:34390 COUNTRY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3161
Mailing Address - Country:US
Mailing Address - Phone:313-300-3530
Mailing Address - Fax:
Practice Address - Street 1:43191 DALCOMA DR STE 102
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6308
Practice Address - Country:US
Practice Address - Phone:586-460-9625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No291U00000XLaboratoriesClinical Medical Laboratory