Provider Demographics
NPI:1093853418
Name:PRO-ACTION, INC.
Entity Type:Organization
Organization Name:PRO-ACTION, INC.
Other - Org Name:IMMUNIZE EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUTUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:915-532-2771
Mailing Address - Street 1:PO BOX 962505
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-2505
Mailing Address - Country:US
Mailing Address - Phone:915-533-3414
Mailing Address - Fax:915-533-3515
Practice Address - Street 1:1400 GEORGE DIETER DR STE 260
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7658
Practice Address - Country:US
Practice Address - Phone:915-533-3414
Practice Address - Fax:915-533-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6973207Q00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017972302Medicaid
TX00882YMedicare ID - Type Unspecified