Provider Demographics
NPI:1780400325
Name:MED PRO SYNERGY, LLC
Entity type:Organization
Organization Name:MED PRO SYNERGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:806-599-6299
Mailing Address - Street 1:5815 82ND ST, STE 145 / PMB 108
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3646
Mailing Address - Country:US
Mailing Address - Phone:806-599-6299
Mailing Address - Fax:
Practice Address - Street 1:4617 50TH ST STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3507
Practice Address - Country:US
Practice Address - Phone:806-599-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service