Provider Information for 1508636986
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PROPRIUM SOLUTIONS LLC
Organization Subpart: NO
NPI: 1508636986
Last Updated: 2024-04-04
Certification Date: 2024-04-04
Certification Date: 2024-04-04
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1508636986 | ||||||||
| Enumeration Date | 2024-01-05 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: JOHN PROVENZA Title: Owner Phone: 3184229348 | ||||||||
| Mailing Address | 3710 YOUREE DR SHREVEPORT, LA 71105-2130 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 3710 YOUREE DR SHREVEPORT, LA 71105-2130 United States Phone: 318-841-6416 | Fax:318-769-0809 | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
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