1598186199 NPI number — PRO K, INC

Table of content: (NPI 1598186199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598186199 NPI number — PRO K, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO K, INC
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:
Provider Other Organization Name Type Code:
6
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:
1598186199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1387 GEORGE DIETER
Provider Second Line Business Mailing Address:
STE A-104
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-595-1300
Provider Business Mailing Address Fax Number:
915-595-1303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1387 GEORGE DIETER
Provider Second Line Business Practice Location Address:
SUITE A-104
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-595-1300
Provider Business Practice Location Address Fax Number:
915-595-1303
Provider Enumeration Date:
12/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MEILI
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
915-595-1300

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  28944 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2143592 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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