Healthcare Provider Details

I. General information

NPI: 1912207556
Provider Name (Legal Business Name): PRO MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14697 80TH PL N STE ML
MAPLE GROVE MN
55311-2154
US

IV. Provider business mailing address

14697 80TH PL N STE #ML P O BOX 1681
MAPLE GROVE MN
55311-6681
US

V. Phone/Fax

Practice location:
  • Phone: 763-390-2561
  • Fax:
Mailing address:
  • Phone: 763-390-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY ADANENE
Title or Position: AUTHORIZED AGENT / OFFICIAL
Credential:
Phone: 763-390-2590