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General NPI Number Information
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NPI Number | 1922161017
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Entity Type | Organization
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Legal Business Name | PRO2 LOUISVILLE, LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 4616 POPLAR LEVEL RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-2338
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Country | US
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Telephone | 502-962-4704
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Fax | 502-962-4760
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Provider Business Mailing Address
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Address Line | 4616 POPLAR LEVEL RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-2338
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Country | US
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Telephone | 502-962-4704
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Fax | 502-962-4760
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Authorized Official
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Title or Position | EVP
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Name | MR. MICHAEL D. MOORE
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Credential | RRT
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Telephone | 502-962-4704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | MG0493
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License Number State | KY
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