Provider Demographics
NPI:1104027655
Name:PRO MED ANALYSIS, LLC
Entity Type:Organization
Organization Name:PRO MED ANALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-326-0818
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-0515
Mailing Address - Country:US
Mailing Address - Phone:704-289-4767
Mailing Address - Fax:
Practice Address - Street 1:711 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-3851
Practice Address - Country:US
Practice Address - Phone:228-432-1192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization