Provider Demographics
NPI:1750485454
Name:PRO-MEDICAL EQUIPMENT, CORP.
Entity Type:Organization
Organization Name:PRO-MEDICAL EQUIPMENT, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:ROMAN IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-922-4170
Mailing Address - Street 1:PO BOX 2071
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-8071
Mailing Address - Country:US
Mailing Address - Phone:787-280-5031
Mailing Address - Fax:787-280-5036
Practice Address - Street 1:CARR 446 KM 0.3
Practice Address - Street 2:BO. GUATEMALA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-4460
Practice Address - Country:US
Practice Address - Phone:787-896-2272
Practice Address - Fax:787-280-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0800970001Medicare ID - Type UnspecifiedPROVIDER NUMBER
PR0800970001Medicare NSC