Provider Demographics
NPI:1114089448
Name:PROS INC
Entity Type:Organization
Organization Name:PROS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:ZIELIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-656-9857
Mailing Address - Street 1:1331 24TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3860
Mailing Address - Country:US
Mailing Address - Phone:406-656-9857
Mailing Address - Fax:406-656-4063
Practice Address - Street 1:1331 24TH ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3860
Practice Address - Country:US
Practice Address - Phone:406-656-9857
Practice Address - Fax:406-656-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0600022915156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT29741OtherBCBS OF MT IDENTIFICATION
MT0551157Medicaid