Provider Demographics
NPI:1073297875
Name:PROCARE NACOGDOCHES LLC
Entity Type:Organization
Organization Name:PROCARE NACOGDOCHES LLC
Other - Org Name:EXCEL ER NACOGDOCHES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-436-8100
Mailing Address - Street 1:1420 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4037
Mailing Address - Country:US
Mailing Address - Phone:936-569-0911
Mailing Address - Fax:936-569-9131
Practice Address - Street 1:1420 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4037
Practice Address - Country:US
Practice Address - Phone:936-569-0911
Practice Address - Fax:936-569-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care