Organization
MEDISTAT GROUP ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERI LOUISE SHIPMAN (OFFICE MANAGER)
(972) 709-1781
Entity
Organization
Contact information
Practice address
2617 BOLTON BOONE DR, SUITE B, DESOTO, TX 75115-2074
(972) 709-1781
(972) 709-1782
Mailing address
2617 BOLTON BOONE DR, SUITE B, DESOTO, TX 75115-2074
(972) 709-1781
(972) 709-1782
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
225B00000X
Pulmonary Function Technologist
—
—
2278P1005X
Pulmonary Rehabilitation Certified Respiratory Therapist
—
—
261QH0100X
Health Service Clinic/Center
G6955
TX
363LA2200X
Adult Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
07/25/2006
Last updated
10/05/2008
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