Provider Demographics
NPI:1992744338
Name:PROMISE MEDICAL, INC.
Entity type:Organization
Organization Name:PROMISE MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:3325 BARTLETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6428
Mailing Address - Country:US
Mailing Address - Phone:407-206-0040
Mailing Address - Fax:407-206-0010
Practice Address - Street 1:1731 GRANDSTAND DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4708
Practice Address - Country:US
Practice Address - Phone:210-804-0565
Practice Address - Fax:210-804-1475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AEROCARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
519916OtherBLUE CROSS BLUE SHIELD
TX10482001Medicaid
TX12065101Medicaid
TX1149900001Medicare NSC