Provider Demographics
NPI: | 1013339555 |
---|---|
Name: | PRO-EPIC, LLC. |
Entity Type: | Organization |
Organization Name: | PRO-EPIC, LLC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOE |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | WRIGHT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 562-805-1876 |
Mailing Address - Street 1: | 3595 INLAND EMPIRE BLVD BLDG 1 |
Mailing Address - Street 2: | SUITE # 1250 |
Mailing Address - City: | ONTARIO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91764-7988 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 909-373-4631 |
Mailing Address - Fax: | 909-373-4634 |
Practice Address - Street 1: | 3595 INLAND EMPIRE BLVD BLDG 1 |
Practice Address - Street 2: | SUITE # 1250 |
Practice Address - City: | ONTARIO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91764-7988 |
Practice Address - Country: | US |
Practice Address - Phone: | 909-373-4631 |
Practice Address - Fax: | 909-373-4634 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-01-17 |
Last Update Date: | 2014-01-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 246ZE0600X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic | Group - Multi-Specialty |
No | 242T00000X | Technologists, Technicians & Other Technical Service Providers | Perfusionist | Group - Multi-Specialty | |
No | 246QB0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Blood Banking | Group - Multi-Specialty |
No | 246QH0401X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Hemapheresis Practitioner | Group - Multi-Specialty |
No | 246RP1900X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy | Group - Multi-Specialty |
No | 246Z00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Group - Multi-Specialty | |
No | 246ZE0500X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | EEG | Group - Multi-Specialty |
No | 246ZS0410X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Surgical Technologist | Group - Multi-Specialty |
No | 247000000X | Technologists, Technicians & Other Technical Service Providers | Technician, Health Information | Group - Multi-Specialty | |
No | 2470A2800X | Technologists, Technicians & Other Technical Service Providers | Technician, Health Information | Assistant Record Technician | Group - Multi-Specialty |