Provider Demographics
NPI:1801195771
Name:PROMED MEDICAL
Entity type:Organization
Organization Name:PROMED MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-242-8079
Mailing Address - Street 1:915 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2133
Mailing Address - Country:US
Mailing Address - Phone:214-773-1875
Mailing Address - Fax:214-242-8079
Practice Address - Street 1:915 SAINT ANDREWS PL
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2133
Practice Address - Country:US
Practice Address - Phone:214-773-1875
Practice Address - Fax:214-242-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies