Provider Demographics
NPI:1952575953
Name:PRO MEDICAL EAST LLC
Entity Type:Organization
Organization Name:PRO MEDICAL EAST LLC
Other - Org Name:PROFESSIONAL MEDICAL ENTERPRISES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:610-525-3162
Mailing Address - Street 1:6555 POWERLINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2067
Mailing Address - Country:US
Mailing Address - Phone:954-677-1011
Mailing Address - Fax:954-677-0922
Practice Address - Street 1:6555 POWERLINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2067
Practice Address - Country:US
Practice Address - Phone:954-677-1011
Practice Address - Fax:954-677-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000006633332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408730500Medicaid
MI540H104220OtherMICHIGAN BC/BS
P2723785OtherAETNA
0005164000OtherKEYSTONE EAST
OK200068890AMedicaid
WI82839600Medicaid
NJ8704805Medicaid
KY90003799Medicaid
SCDM1174Medicaid
OH2272955Medicaid
000246014OtherHIGHMARK BC/BS
MI4344350Medicaid
MN625683800Medicaid
0005164000OtherAMERIHEALTH
PA0018611300003Medicaid
TN4582539Medicaid
OH2272955Medicaid
WI82839600Medicaid
NJ8704805Medicaid
PA4245340001Medicare NSC