Provider Demographics
NPI:1407396047
Name:PRO MED MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:PRO MED MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-444-4832
Mailing Address - Street 1:3435 BELMONT TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1302
Mailing Address - Country:US
Mailing Address - Phone:954-444-4832
Mailing Address - Fax:
Practice Address - Street 1:3435 BELMONT TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1302
Practice Address - Country:US
Practice Address - Phone:954-444-4832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies