Provider Demographics
NPI:1336695576
Name:PROCARE HEALTHSPOT, LLC
Entity Type:Organization
Organization Name:PROCARE HEALTHSPOT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-491-3856
Mailing Address - Street 1:3434 W STATE ROAD 66
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3434 W STATE ROAD 66
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635
Practice Address - Country:US
Practice Address - Phone:812-491-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVEHEALTH OF INDIANA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-28
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health