Organization
MEDISTAT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID B SCOTT MBA, ATP (PRESIDENT & CEO)
(731) 660-0060
Entity
Organization
Contact information
Practice address
935 OLD HUMBOLDT RD, SUITE A, JACKSON, TN 38305-9625
(731) 660-0060
(731) 660-0622
Mailing address
PO BOX 10728, JACKSON, TN 38308-0112
(731) 660-0060
(731) 660-0622
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0000000806
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104735
BLUE CROSS BLUE SHIELD
TN
05
—
3558573
—
TN
Enumeration date
02/07/2007
Last updated
09/23/2013
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