Provider Demographics
NPI:1194405886
Name:PRIDEFUL MEDPORT LLC
Entity type:Organization
Organization Name:PRIDEFUL MEDPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-637-5754
Mailing Address - Street 1:925 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2813
Mailing Address - Country:US
Mailing Address - Phone:740-771-3323
Mailing Address - Fax:
Practice Address - Street 1:925 DAYTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2813
Practice Address - Country:US
Practice Address - Phone:740-771-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company