# MEDISTAT GROUP ASSOCIATES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376565341
- **Authorized official:** MRS. TERI LOUISE SHIPMAN (OFFICE MANAGER)
- **Authorized official phone:** (972) 709-1781

## Contact information

- **Practice address:** 2617 BOLTON BOONE DR, SUITE B, DESOTO, TX 75115-2074
- **Practice address phone:** (972) 709-1781
- **Practice address fax:** (972) 709-1782
- **Mailing address:** 2617 BOLTON BOONE DR, SUITE B, DESOTO, TX 75115-2074
- **Mailing address phone:** (972) 709-1781
- **Mailing address fax:** (972) 709-1782

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 225B00000X | Pulmonary Function Technologist | — | NULL | — |
| 225B00000X | Pulmonary Function Technologist | — | — | — |
| 2278P1005X | Pulmonary Rehabilitation Certified Respiratory Therapist | — | NULL | — |
| 2278P1005X | Pulmonary Rehabilitation Certified Respiratory Therapist | — | — | — |
| 261QH0100X | Health Service Clinic/Center | G6955 | TX | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 10/05/2008