Provider Demographics
NPI:1225366511
Name:MEDIATION PRO, INC.
Entity type:Organization
Organization Name:MEDIATION PRO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-939-7767
Mailing Address - Street 1:1411 N WESTSHORE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4515
Mailing Address - Country:US
Mailing Address - Phone:888-939-7767
Mailing Address - Fax:866-507-8362
Practice Address - Street 1:1411 N WESTSHORE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4515
Practice Address - Country:US
Practice Address - Phone:888-939-7767
Practice Address - Fax:866-507-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)