Provider Demographics
NPI:1073607297
Name:PROCARE MEDICAL, INC
Entity Type:Organization
Organization Name:PROCARE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-695-2203
Mailing Address - Street 1:210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEELE
Mailing Address - State:MO
Mailing Address - Zip Code:63877-1436
Mailing Address - Country:US
Mailing Address - Phone:573-695-2203
Mailing Address - Fax:573-695-2510
Practice Address - Street 1:113 E HALE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-2621
Practice Address - Country:US
Practice Address - Phone:870-563-2242
Practice Address - Fax:870-563-7972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCARE MEDICAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123164716Medicaid
AR0477920003Medicare NSC