Provider Demographics
NPI:1902258916
Name:PRO DME LLC
Entity Type:Organization
Organization Name:PRO DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOHNCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-412-8087
Mailing Address - Street 1:2136 S RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2606
Mailing Address - Country:US
Mailing Address - Phone:888-412-8087
Mailing Address - Fax:888-522-0355
Practice Address - Street 1:2136 S RICHARDS ST STE B
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-2606
Practice Address - Country:US
Practice Address - Phone:877-655-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies