Prodigious Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PRODIGIOUS INC

Practice address

1103 Galvin Rd S Ste L 1/2
Bellevue, NE 68005-3002

Phone

(470) 275-4896

NPI assigned

Oct 4, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Valencia Elliott

Title

President

Phone

(404) 563-0137

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1487379236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6707 CHAPARRAL DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300383105",
            "telephone_number": "470-275-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 GALVIN RD S STE L 1/2",
            "city": "BELLEVUE",
            "state": "NE",
            "postal_code": "680053002",
            "telephone_number": "470-275-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGIOUS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "VALENCIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-563-0137"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Bellevue, NE
• Providers in Bellevue, NE by specialty
• Durable Medical Equipment & Medical Supplies in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.