Provider Demographics
NPI:1073749941
Name:PRO MEDICAL STAFFING, INC.
Entity Type:Organization
Organization Name:PRO MEDICAL STAFFING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ODS
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:O
Authorized Official - Last Name:BASSEY-BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-420-3183
Mailing Address - Street 1:7964 BROOKLYN BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2722
Mailing Address - Country:US
Mailing Address - Phone:763-420-3183
Mailing Address - Fax:763-494-6664
Practice Address - Street 1:7964 BROOKLYN BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2722
Practice Address - Country:US
Practice Address - Phone:763-420-3183
Practice Address - Fax:763-494-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343805251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA512419100Medicaid