Provider Demographics
NPI:1730204199
Name:PROCARE MEDICAL,INC.
Entity type:Organization
Organization Name:PROCARE MEDICAL,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDALA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-883-3453
Mailing Address - Street 1:1406 S WALTON BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6626
Mailing Address - Country:US
Mailing Address - Phone:866-883-3453
Mailing Address - Fax:
Practice Address - Street 1:1406 S WALTON BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6626
Practice Address - Country:US
Practice Address - Phone:866-883-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies