1770809238 NPI number — PROMAS LLC

Table of content: (NPI 1770809238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770809238 NPI number — PROMAS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMAS 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:
Provider Other Organization Name Type Code:
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:
1770809238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71135-2078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-828-9227
Provider Business Mailing Address Fax Number:
318-861-4724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1453 E BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-681-4126
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
ROSCOE
Authorized Official Middle Name:
HO-KEUNG
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-681-4126

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  014269R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 183754002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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