Healthcare Provider Details

I. General information

NPI: 1649890807
Provider Name (Legal Business Name): PROMED SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6986 E MARY DR
TUCSON AZ
85730-1713
US

IV. Provider business mailing address

6986 E MARY DR
TUCSON AZ
85730-1713
US

V. Phone/Fax

Practice location:
  • Phone: 520-861-8566
  • Fax: 866-775-1988
Mailing address:
  • Phone: 520-861-8566
  • Fax: 866-775-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNESTO ANTONIO LEVARIO
Title or Position: MEMBER
Credential: PBT-ASCP
Phone: 520-861-8566