Provider Demographics
NPI:1689279705
Name:MED-CARE LLC
Entity Type:Organization
Organization Name:MED-CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DURWOOD
Authorized Official - Middle Name:F
Authorized Official - Last Name:GANDEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:681-758-5141
Mailing Address - Street 1:27 TROVATO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7285
Mailing Address - Country:US
Mailing Address - Phone:681-758-5141
Mailing Address - Fax:304-623-6302
Practice Address - Street 1:27 TROVATO ST STE 101
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-7285
Practice Address - Country:US
Practice Address - Phone:681-758-5141
Practice Address - Fax:304-623-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty