Provider Demographics
NPI:1700010097
Name:PROCARE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:PROCARE MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:414-254-4020
Mailing Address - Street 1:S93W31636 GENA DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8273
Mailing Address - Country:US
Mailing Address - Phone:414-254-4020
Mailing Address - Fax:
Practice Address - Street 1:S93W31636 GENA DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8273
Practice Address - Country:US
Practice Address - Phone:414-254-4020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies