Provider Demographics
NPI:1568543007
Name:PRO MEDICAL SUPPLIES AND SERVICES
Entity Type:Organization
Organization Name:PRO MEDICAL SUPPLIES AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-960-2412
Mailing Address - Street 1:PO BOX 10302
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78460-0302
Mailing Address - Country:US
Mailing Address - Phone:361-334-0774
Mailing Address - Fax:361-334-0881
Practice Address - Street 1:3833 S STAPLES ST
Practice Address - Street 2:SUITE N201
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5201
Practice Address - Country:US
Practice Address - Phone:361-334-0774
Practice Address - Fax:361-334-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies