Provider Demographics
NPI:1659861094
Name:PRO-CARE FAMILY HEALTH OF ARKANSAS, LLC
Entity Type:Organization
Organization Name:PRO-CARE FAMILY HEALTH OF ARKANSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOOLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-414-5680
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1278
Mailing Address - Country:US
Mailing Address - Phone:918-647-0670
Mailing Address - Fax:918-647-0460
Practice Address - Street 1:706 SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:BONANZA
Practice Address - State:AR
Practice Address - Zip Code:72916-3420
Practice Address - Country:US
Practice Address - Phone:479-255-6095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty