Provider Demographics
NPI:1316598618
Name:PROLYFE MEDICAL BILLING
Entity Type:Organization
Organization Name:PROLYFE MEDICAL BILLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-655-1224
Mailing Address - Street 1:11655 BRIAR FOREST DR APT 134
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5038
Mailing Address - Country:US
Mailing Address - Phone:409-655-1224
Mailing Address - Fax:
Practice Address - Street 1:11655 BRIAR FOREST DR APT 134
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5038
Practice Address - Country:US
Practice Address - Phone:409-655-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty