Provider Demographics
NPI:1457024408
Name:PRO2 LLC
Entity Type:Organization
Organization Name:PRO2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS / COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-829-9813
Mailing Address - Street 1:3586 CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1746
Mailing Address - Country:US
Mailing Address - Phone:716-667-9600
Mailing Address - Fax:
Practice Address - Street 1:1120 YOUNGS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2695
Practice Address - Country:US
Practice Address - Phone:716-923-2727
Practice Address - Fax:716-608-8777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRO2, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies