Provider Demographics
NPI:1710476726
Name:PROCARE, IPA INC
Entity Type:Organization
Organization Name:PROCARE, IPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-263-6774
Mailing Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 6500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2585
Mailing Address - Country:US
Mailing Address - Phone:323-263-6774
Mailing Address - Fax:323-263-1277
Practice Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 6500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2585
Practice Address - Country:US
Practice Address - Phone:323-263-6774
Practice Address - Fax:323-263-1277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE EYE MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-04
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID