Healthcare Provider Details

I. General information

NPI: 1942699384
Provider Name (Legal Business Name): MEDPRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W LEXINGTON RD
EATON OH
45320-9282
US

IV. Provider business mailing address

251 W LEXINGTON RD
EATON OH
45320-9282
US

V. Phone/Fax

Practice location:
  • Phone: 937-336-5586
  • Fax: 937-336-5494
Mailing address:
  • Phone: 937-336-5586
  • Fax: 937-336-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number680122
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number680122
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number685135
License Number StateOH

VIII. Authorized Official

Name: MRS. GINA R. HATMAKER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 937-336-5586