Provider Demographics
NPI:1609386036
Name:MEDPROS OF THE TREASURE COAST
Entity Type:Organization
Organization Name:MEDPROS OF THE TREASURE COAST
Other - Org Name:ION MY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-660-7094
Mailing Address - Street 1:7050 W 120TH AVE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7602
Mailing Address - Country:US
Mailing Address - Phone:800-660-7097
Mailing Address - Fax:877-234-5340
Practice Address - Street 1:7050 W 120TH AVE UNIT 10
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7602
Practice Address - Country:US
Practice Address - Phone:800-660-7097
Practice Address - Fax:877-234-5340
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDPROS OF THE TREASURE COAST INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20176000941332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20176000941OtherDME SUPPLIER LICENSE