Provider Demographics
NPI:1043871403
Name:PROMED SUPPLY LLC
Entity Type:Organization
Organization Name:PROMED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATATANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-616-4348
Mailing Address - Street 1:16045 SHERMAN WAY STE C
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4085
Mailing Address - Country:US
Mailing Address - Phone:818-616-4348
Mailing Address - Fax:818-616-4134
Practice Address - Street 1:16045 SHERMAN WAY STE C
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4085
Practice Address - Country:US
Practice Address - Phone:818-616-4348
Practice Address - Fax:818-616-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty