Medistat, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0000000806 Issued in TN

Legal business name

MEDISTAT, INC

Practice address

935 Old Humboldt Rd
Suite a
Jackson, TN 38305-9625

Phone

(731) 660-0060

Fax

(731) 660-0622

NPI assigned

Feb 7, 2007

Last updated

Sep 23, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David B Scott, MBA, ATP

Title

President & Ceo

Phone

(731) 660-0060

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1932249075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10728",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383080112",
            "telephone_number": "731-660-0060",
            "fax_number": "731-660-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 OLD HUMBOLDT RD",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383059625",
            "telephone_number": "731-660-0060",
            "fax_number": "731-660-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDISTAT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "731-660-0060",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, ATP"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "0000000806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "104735",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3558573",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.