Medistat

Primary specialty

SpecialistTaxonomy code 174400000X

License

3201006614 Issued in MI

Legal business name

MEDISTAT

Practice address

8511 Oakville Waltz Rd
Belleville, MI 48111-9504

Phone

(248) 914-6015

NPI assigned

Jul 5, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dorthia Carolyn Glover, CCEMT-P

Title

Paramedic/Medical Assistant

Phone

(734) 587-2217

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1851688428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8511 OAKVILLE WALTZ RD",
            "city": "BELLEVILLE",
            "state": "MI",
            "postal_code": "481119504",
            "telephone_number": "248-914-6015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8511 OAKVILLE WALTZ RD",
            "city": "BELLEVILLE",
            "state": "MI",
            "postal_code": "481119504",
            "telephone_number": "248-914-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDISTAT",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-05",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "DORTHIA",
        "authorized_official_middle_name": "CAROLYN",
        "authorized_official_title_or_position": "PARAMEDIC/MEDICAL ASSISTANT",
        "authorized_official_telephone_number": "734-587-2217",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CCEMT-P"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "3201006614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Belleville, MI
• Providers in Belleville, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.