Provider Demographics
NPI:1417171075
Name:MEDPRO MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:MEDPRO MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-295-7665
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-0807
Mailing Address - Country:US
Mailing Address - Phone:936-295-7665
Mailing Address - Fax:936-295-5676
Practice Address - Street 1:1425 HWY 75 N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320
Practice Address - Country:US
Practice Address - Phone:936-295-7665
Practice Address - Fax:936-295-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300257341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB090Medicare ID - Type Unspecified