MEDICARE: PRO DME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1902258916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO DME LLC

Provider Business Mailing Address
First Line	:	2136 S RICHARDS ST
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-2606
Country	:	US
Telephone Number	:	888-412-8087
Fax Number	:	888-522-0355

Provider Business Practice Location Address
First Line	:	2136 S RICHARDS ST STE B
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-2606
Country	:	US
Telephone Number	:	877-655-7654
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DARIN WILLIAM JOHNCOCK
Credential	:
Telephone Number	:	888-412-8087

Provider Enumeration Date	:	07/01/2016
Last Update Date	:	02/08/2024

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