Provider Demographics
NPI:1972178275
Name:PROPHYLAXIS PRIMARY CARE AND BEHAVIORAL HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:PROPHYLAXIS PRIMARY CARE AND BEHAVIORAL HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-263-2690
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-0334
Mailing Address - Country:US
Mailing Address - Phone:918-970-4719
Mailing Address - Fax:
Practice Address - Street 1:12816 S MEMORIAL DR UNIT 121
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2593
Practice Address - Country:US
Practice Address - Phone:918-970-4719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care