| Organization Name: | PRODIGY MEDICAL, LLC |
| NPI Number: | 1073551131 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BERENICE I HALPIN (PARTNER) |
| Mailing Address: | 347 W Danview Ave Homer |
| State: | AK US |
| Postal Code: | 996037028 |
| Phone Number: | 9072263400 |
| Fax Number: | 9072263300 |
| NPI Enumeration Date: | 06/02/2006 |
| NPI Last Update Date: | 09/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 991850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |