1104851674 NPI number — PRO2 INDIANAPOLIS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104851674 NPI number — PRO2 INDIANAPOLIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO2 INDIANAPOLIS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRO2 RESPIRATORY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104851674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7164 ZIONSVILLE RD
Provider Second Line Business Mailing Address:
PARK 100, BUILDING 106
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46268-2163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-298-7700
Provider Business Mailing Address Fax Number:
317-299-7707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7164 ZIONSVILLE RD
Provider Second Line Business Practice Location Address:
PARK 100
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46268-2163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-298-7700
Provider Business Practice Location Address Fax Number:
317-299-7707
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORD
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-469-5771

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200800600B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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