Provider Demographics
NPI:1689158685
Name:PROCORE SELECT, LLC.
Entity Type:Organization
Organization Name:PROCORE SELECT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-721-9427
Mailing Address - Street 1:17300 DALLAS PKWY STE 1075
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-7713
Mailing Address - Country:US
Mailing Address - Phone:469-640-0849
Mailing Address - Fax:
Practice Address - Street 1:17300 DALLAS PKWY STE 1075
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-7713
Practice Address - Country:US
Practice Address - Phone:469-640-0849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies