Provider Demographics
NPI:1952620205
Name:MEDPROS OF THE TREASURE COAST
Entity Type:Organization
Organization Name:MEDPROS OF THE TREASURE COAST
Other - Org Name:ION MY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-660-7094
Mailing Address - Street 1:185 E INDIANTOWN RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5049
Mailing Address - Country:US
Mailing Address - Phone:800-660-7094
Mailing Address - Fax:877-234-5340
Practice Address - Street 1:185 E INDIANTOWN RD
Practice Address - Street 2:SUITE 205
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5049
Practice Address - Country:US
Practice Address - Phone:800-660-7094
Practice Address - Fax:877-234-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6480990001Medicare NSC
FL6480990001Medicare NSC