Provider Demographics
NPI:1902431794
Name:PRODIGEE INVESTMENT GROUP LLC
Entity Type:Organization
Organization Name:PRODIGEE INVESTMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:813-777-1263
Mailing Address - Street 1:4501 CLEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-7335
Mailing Address - Country:US
Mailing Address - Phone:813-620-6262
Mailing Address - Fax:813-535-9128
Practice Address - Street 1:3504 N 10TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1040
Practice Address - Country:US
Practice Address - Phone:813-777-1263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities