Provider Demographics
NPI:1336531888
Name:PRO CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:PRO CARE MEDICAL GROUP
Other - Org Name:HEALTH MED CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-416-3322
Mailing Address - Street 1:205 STEWART RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-9607
Mailing Address - Country:US
Mailing Address - Phone:360-416-3322
Mailing Address - Fax:360-707-7103
Practice Address - Street 1:205 STEWART RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-9607
Practice Address - Country:US
Practice Address - Phone:360-416-3322
Practice Address - Fax:360-707-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60118940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPENDINGMedicare PIN