Provider Demographics
NPI:1053802264
Name:STEM CELL PROS LLC
Entity type:Organization
Organization Name:STEM CELL PROS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KNUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-937-5882
Mailing Address - Street 1:213 EDINBURGH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7328
Mailing Address - Country:US
Mailing Address - Phone:817-937-5882
Mailing Address - Fax:800-300-0431
Practice Address - Street 1:4100 HARRY HINES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:817-937-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies