Provider Demographics
NPI:1811957467
Name:PRO-MED, P.C.
Entity type:Organization
Organization Name:PRO-MED, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-382-0530
Mailing Address - Street 1:302 PAUL STABLER DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3128
Mailing Address - Country:US
Mailing Address - Phone:334-382-0530
Mailing Address - Fax:334-382-0498
Practice Address - Street 1:302 PAUL STABLER DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3871
Practice Address - Country:US
Practice Address - Phone:334-382-0530
Practice Address - Fax:334-382-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030326Medicaid
ALF73658Medicare UPIN
AL000030326Medicaid
AL000030326Medicare PIN