1811094857 NPI number — PRO MEDICAL CORPORATION

Table of content: (NPI 1811094857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811094857 NPI number — PRO MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRO MEDICAL CORPORATION
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:
1811094857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066-8118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-230-3000
Provider Business Mailing Address Fax Number:
615-230-3029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 HANCOCK ST
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
GALLATIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37066-6346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-230-3000
Provider Business Practice Location Address Fax Number:
615-230-3029
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYONS
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SEC
Authorized Official Telephone Number:
615-230-3000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4441503 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1455002 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com