MEDISTAT GROUP ASSOCIATES INC. NPI 1376565341

NPI Information

  • NPI: 1376565341
  • Provider Name: MEDISTAT GROUP ASSOCIATES, INC.
  • Classification: Family Medicine - 207QA0505X
  • Specialization: Adult Medicine
  • Entity Type: Organization
  • Address: 2617 BOLTON BOONE DR
    SUITE B
    DESOTO, TX
    ZIP 75115
  • Phone: (972) 709-1781

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NPI Details

MEDISTAT GROUP ASSOCIATES, INC. is an adult medicine family medicine in Desoto, TX. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. MEDISTAT GROUP ASSOCIATES, INC. NPI is 1376565341. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2617 BOLTON BOONE DR
SUITE B
DESOTO, TX
ZIP 75115-074
Phone: (972) 709-1781
Fax: (972) 709-1782

The provider's authorized official is Teri Louise Shipman .
The authorized official title is Office Manager and has the following contact phone number (972) 709-1781.

The enumeration date for this NPI number is 7/25/2006 and was last updated on 10/5/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2200XNurse PractitionerAdult HealthNo
2363LP2300XNurse PractitionerPrimary CareNo
3225B00000XPulmonary Function TechnologistNo
42278P1005XRespiratory Therapist, CertifiedPulmonary RehabilitationNo
52081P2900XPhysical Medicine & RehabilitationPain MedicineNo
6261QH0100XClinic/CenterHealth ServiceG6955TEXASNo
7207QA0505XFamily MedicineAdult MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1C18105MEDICARE UPINTEXAS
28684B9MEDICARE ID-TYPE UNSPECIFIEDTEXASJACQUES ROY, M.D
300728TMEDICARE ID-TYPE UNSPECIFIEDTEXASGROUP NUMBER
48943B6MEDICARE ID-TYPE UNSPECIFIEDTEXASLOUISE LAMARRE, M.D.
5C21376MEDICARE UPINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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