Provider Demographics
NPI:1023753837
Name:PROCARE MEDICAL COMPANY
Entity type:Organization
Organization Name:PROCARE MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-945-1805
Mailing Address - Street 1:759 FLORY MILL RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2733
Mailing Address - Country:US
Mailing Address - Phone:717-945-1805
Mailing Address - Fax:877-528-0421
Practice Address - Street 1:759 FLORY MILL RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2733
Practice Address - Country:US
Practice Address - Phone:717-945-1805
Practice Address - Fax:877-528-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103302830Medicaid