Provider Demographics
NPI:1528211109
Name:PRO HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PRO HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-818-7676
Mailing Address - Street 1:7028 W WATERS AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2292
Mailing Address - Country:US
Mailing Address - Phone:813-818-7676
Mailing Address - Fax:866-882-4326
Practice Address - Street 1:6601 MEMORIAL HWY STE 117
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4501
Practice Address - Country:US
Practice Address - Phone:813-818-7676
Practice Address - Fax:866-882-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1314215332B00000X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies