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General NPI Number Information
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NPI Number | 1144912247
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Entity Type | Organization
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Legal Business Name | PMR HEALTHCARE
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 210 E SHERMAN AVE STE 204
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2750
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Country | US
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Telephone | 208-664-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 7399 N SHADELAND AVE # 103
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2052
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Country | US
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Telephone | 317-845-5974
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | JOSEPH DAVID DONADIO
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Credential | EMT-P
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Telephone | 317-845-5974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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