Basic Information
| Provider Information | |||||||||
| NPI: | 1235809013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KYPUROS MEDICAL VENTURES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROHEALTH INPATIENT CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7585 KITTY HAWK RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781092820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104682333 | ||||||||
| FaxNumber: | 2106674044 | ||||||||
| Practice Location | |||||||||
| Address1: | 7585 KITTY HAWK RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781092820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104682333 | ||||||||
| FaxNumber: | 2106674044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2021 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | KYPUROS | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2104682333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.