Provider Demographics
NPI:1922161017
Name:PRO2 LOUISVILLE, LLC
Entity Type:Organization
Organization Name:PRO2 LOUISVILLE, LLC
Other - Org Name:PRO2 RESPIRATORY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:502-962-4704
Mailing Address - Street 1:4616 POPLAR LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-2338
Mailing Address - Country:US
Mailing Address - Phone:502-962-4704
Mailing Address - Fax:502-962-4760
Practice Address - Street 1:4616 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2338
Practice Address - Country:US
Practice Address - Phone:502-962-4704
Practice Address - Fax:502-962-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0493332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90012162Medicaid
KY90012162Medicaid