Provider Demographics
NPI:1104851674
Name:PRO2 INDIANAPOLIS, LLC
Entity Type:Organization
Organization Name:PRO2 INDIANAPOLIS, LLC
Other - Org Name:PRO2 RESPIRATORY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-469-5771
Mailing Address - Street 1:7164 ZIONSVILLE RD
Mailing Address - Street 2:PARK 100, BUILDING 106
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2163
Mailing Address - Country:US
Mailing Address - Phone:317-298-7700
Mailing Address - Fax:317-299-7707
Practice Address - Street 1:7164 ZIONSVILLE RD
Practice Address - Street 2:PARK 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2163
Practice Address - Country:US
Practice Address - Phone:317-298-7700
Practice Address - Fax:317-299-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200800600BMedicaid
IN200800600BMedicaid