Provider Demographics
NPI:1386048668
Name:PROHEALTH MEDICAL, LTD.
Entity type:Organization
Organization Name:PROHEALTH MEDICAL, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENA
Authorized Official - Middle Name:LARIVIERE
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-963-6500
Mailing Address - Street 1:2623 E HELEN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3619
Mailing Address - Country:US
Mailing Address - Phone:206-963-6500
Mailing Address - Fax:866-521-0472
Practice Address - Street 1:1233 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2147
Practice Address - Country:US
Practice Address - Phone:425-502-8098
Practice Address - Fax:866-521-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty