Provider Demographics
NPI:1891563979
Name:PR MANUFACTURING
Entity Type:Organization
Organization Name:PR MANUFACTURING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-223-2957
Mailing Address - Street 1:1805 RIVERWAY DR
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-9309
Mailing Address - Country:US
Mailing Address - Phone:800-223-2957
Mailing Address - Fax:
Practice Address - Street 1:1805 RIVERWAY DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-9309
Practice Address - Country:US
Practice Address - Phone:800-223-2957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier