Provider Demographics
NPI:1942439468
Name:PROMETHEUS GROUP
Entity Type:Organization
Organization Name:PROMETHEUS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-423-7065
Mailing Address - Street 1:11325 N COMMUNITY HOUSE RD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1978
Mailing Address - Country:US
Mailing Address - Phone:678-423-7065
Mailing Address - Fax:
Practice Address - Street 1:11325 N COMMUNITY HOUSE RD
Practice Address - Street 2:SUITE 650
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1978
Practice Address - Country:US
Practice Address - Phone:678-423-7065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies