Healthcare Provider Details

I. General information

NPI: 1902831472
Provider Name (Legal Business Name): PRO2 RESPIRATORY SERVICES LIMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 HARDING HWY
LIMA OH
45804-5512
US

IV. Provider business mailing address

3021 HARDING HWY
LIMA OH
45804-5512
US

V. Phone/Fax

Practice location:
  • Phone: 419-224-7702
  • Fax: 419-224-7705
Mailing address:
  • Phone: 419-224-7702
  • Fax: 419-224-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2643821
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: MR. TIMOTHY FORD
Title or Position: PRESIDENT
Credential:
Phone: 513-469-5771