Provider Demographics
NPI:1811094857
Name:PRO MEDICAL CORPORATION
Entity type:Organization
Organization Name:PRO MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-230-3000
Mailing Address - Street 1:PO BOX 8118
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8118
Mailing Address - Country:US
Mailing Address - Phone:615-230-3000
Mailing Address - Fax:615-230-3029
Practice Address - Street 1:179 HANCOCK ST
Practice Address - Street 2:STE 303
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6346
Practice Address - Country:US
Practice Address - Phone:615-230-3000
Practice Address - Fax:615-230-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4441503OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TN1455002Medicaid
TN5555730001Medicare NSC