Provider Demographics
NPI:1235800335
Name:PROPHYLAXIS HEALTHCARE LLC
Entity Type:Organization
Organization Name:PROPHYLAXIS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-263-2690
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-0334
Mailing Address - Country:US
Mailing Address - Phone:918-970-2886
Mailing Address - Fax:
Practice Address - Street 1:211 S MILL ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-5221
Practice Address - Country:US
Practice Address - Phone:918-825-3777
Practice Address - Fax:918-825-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health