Provider Demographics
NPI:1164203774
Name:TRUCARE CONCEPTS LLC
Entity Type:Organization
Organization Name:TRUCARE CONCEPTS LLC
Other - Org Name:TRUCARE CONCEPTS HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-499-1765
Mailing Address - Street 1:802 N WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:OK
Mailing Address - Zip Code:74029-1838
Mailing Address - Country:US
Mailing Address - Phone:918-534-2262
Mailing Address - Fax:
Practice Address - Street 1:802 N WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029-1838
Practice Address - Country:US
Practice Address - Phone:918-534-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty