Provider Demographics
NPI:1801087507
Name:PROCARE MEDICAL INC.
Entity type:Organization
Organization Name:PROCARE MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MGR
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-695-2203
Mailing Address - Street 1:603 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2409
Mailing Address - Country:US
Mailing Address - Phone:870-776-1892
Mailing Address - Fax:870-776-1894
Practice Address - Street 1:603 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2409
Practice Address - Country:US
Practice Address - Phone:870-776-1892
Practice Address - Fax:870-776-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27493578003332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies