Provider Demographics
NPI:1679075568
Name:PRO MED SURGICAL, LLC
Entity Type:Organization
Organization Name:PRO MED SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CLINT
Authorized Official - Last Name:LOGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-781-9021
Mailing Address - Street 1:141 RIDGEWAY DRIVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3402
Mailing Address - Country:US
Mailing Address - Phone:337-761-6555
Mailing Address - Fax:337-284-3052
Practice Address - Street 1:141 RIDGEWAY DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3402
Practice Address - Country:US
Practice Address - Phone:337-761-6555
Practice Address - Fax:337-284-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies