Provider Demographics
NPI:1750564233
Name:PROCARE MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:PROCARE MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-667-5846
Mailing Address - Street 1:527 W PARK CIR
Mailing Address - Street 2:
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3548
Mailing Address - Country:US
Mailing Address - Phone:336-667-5846
Mailing Address - Fax:336-667-8376
Practice Address - Street 1:627 WEST PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3563
Practice Address - Country:US
Practice Address - Phone:336-667-5846
Practice Address - Fax:336-667-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2010388FOtherMEDICARE PTAN, INDIVIDUAL (WPN)
NC146020OtherPC CERT OF REGISTRATION
NC891326FMedicaid
NC5909162Medicaid
NC2010388FOtherMEDICARE PTAN, INDIVIDUAL (WPN)
NC5909162Medicaid