Provider Demographics
NPI:1538194006
Name:PRO2 PHILADELPHIA, LLC
Entity type:Organization
Organization Name:PRO2 PHILADELPHIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-469-5771
Mailing Address - Street 1:761 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1435
Mailing Address - Country:US
Mailing Address - Phone:610-278-1623
Mailing Address - Fax:610-278-1624
Practice Address - Street 1:761 5TH AVE
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1435
Practice Address - Country:US
Practice Address - Phone:610-278-1623
Practice Address - Fax:610-278-1624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094412Medicaid
DE1000036013Medicaid
PA101133493Medicaid
NJ0094412Medicaid