Provider Demographics
NPI:1942699384
Name:MEDPRO LLC
Entity Type:Organization
Organization Name:MEDPRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HATMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-336-5586
Mailing Address - Street 1:251 W LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9282
Mailing Address - Country:US
Mailing Address - Phone:937-336-5586
Mailing Address - Fax:937-336-5494
Practice Address - Street 1:251 W LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9282
Practice Address - Country:US
Practice Address - Phone:937-336-5586
Practice Address - Fax:937-336-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH680122341600000X, 3416L0300X
OH685135343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0128268Medicaid
OHH232200Medicare PIN