Provider Demographics
NPI:1306871975
Name:PRO2 KALAMAZOO, LLC
Entity type:Organization
Organization Name:PRO2 KALAMAZOO, 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 1:3325 RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-1439
Mailing Address - Country:US
Mailing Address - Phone:269-553-7762
Mailing Address - Fax:269-553-9520
Practice Address - Street 1:3325 RAVINE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-1439
Practice Address - Country:US
Practice Address - Phone:269-553-7762
Practice Address - Fax:269-553-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5514600001Medicare NSC