MEDICARE: PRO-CARE MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)		NV

General Provider Information

NPI Number	:	1780701714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-CARE MEDICAL

Provider Business Mailing Address
First Line	:	4420 ARVILLE ST
Second Line	:	SUITE #39
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3742
Country	:	US
Telephone Number	:	702-740-4138
Fax Number	:	702-740-4153

Provider Business Practice Location Address
First Line	:	4420 ARVILLE ST
Second Line	:	SUITE #39
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3742
Country	:	US
Telephone Number	:	702-740-4138
Fax Number	:	702-740-4153

Authorized Official
Title or Position	:	OPERATIONS MANGER
Name	:	MR. CHARLES SINCLAIR HOLTZCLAW
Credential	:
Telephone Number	:	702-740-4138

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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Directions to “PRO-CARE MEDICAL ” Practice Location

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