MEDICARE: AMERICAN PROHEALTH

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	363L00000X	Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1942711064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN PROHEALTH

Provider Business Mailing Address
First Line	:	20602 ARCH STREET PIKE
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20602 ARCH STREET PIKE
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9442
Country	:	US
Telephone Number	:	501-804-8564
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SANJAY DASS
Credential	:	MD
Telephone Number	:	501-626-0053

Provider Enumeration Date	:	10/16/2017
Last Update Date	:	04/19/2019

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Directions to “AMERICAN PROHEALTH ” Practice Location

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