Provider Demographics
NPI:1982647954
Name:PROFESSIONALS PRN LLC
Entity Type:Organization
Organization Name:PROFESSIONALS PRN LLC
Other - Org Name:NORTHSIDE OXYGEN & MEDICAL EQUIPMENT PERRY COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:B
Authorized Official - Last Name:STICKRATH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-454-5666
Mailing Address - Street 1:1132 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2658
Mailing Address - Country:US
Mailing Address - Phone:740-454-5666
Mailing Address - Fax:740-452-7563
Practice Address - Street 1:301 DR. MIKE CLOUSE DRIVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:OH
Practice Address - Zip Code:43783
Practice Address - Country:US
Practice Address - Phone:740-743-1590
Practice Address - Fax:740-743-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021273150332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2380749Medicaid
OH2380749Medicaid