Provider Demographics
NPI:1750572368
Name:PROMED HEALTHCARE, PLLC
Entity type:Organization
Organization Name:PROMED HEALTHCARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-688-9650
Mailing Address - Street 1:7004 SMITH CORNERS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3793
Mailing Address - Country:US
Mailing Address - Phone:704-688-9650
Mailing Address - Fax:704-688-9651
Practice Address - Street 1:7004 SMITH CORNERS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3793
Practice Address - Country:US
Practice Address - Phone:704-688-9650
Practice Address - Fax:704-688-9651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPRESSMED MEDICAL CLINICS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2277046DMedicare PIN