Provider Demographics
NPI:1134781214
Name:PROTALUS USA LLC
Entity type:Organization
Organization Name:PROTALUS USA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SALES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-944-1233
Mailing Address - Street 1:1750 BLANKENSHIP RD STE 125
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-5104
Mailing Address - Country:US
Mailing Address - Phone:518-944-1233
Mailing Address - Fax:
Practice Address - Street 1:1750 BLANKENSHIP RD STE 125
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-5104
Practice Address - Country:US
Practice Address - Phone:518-944-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROTALUS HOLDINGS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies