Healthcare Provider Details

I. General information

NPI: 1316975402
Provider Name (Legal Business Name): HEALTH PRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 ELECTRIC RD SUITE 400
ROANOKE VA
24018-4562
US

IV. Provider business mailing address

3959 ELECTRIC RD SUITE 400
ROANOKE VA
24018-4562
US

V. Phone/Fax

Practice location:
  • Phone: 540-777-1011
  • Fax: 540-777-1004
Mailing address:
  • Phone: 540-777-1011
  • Fax: 540-777-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberBUS. LICENSE #22659
License Number StateVA

VIII. Authorized Official

Name: TYLER M. MOORE
Title or Position: MANAGING MEMBER
Credential:
Phone: 540-777-1011