Healthcare Provider Details

I. General information

NPI: 1831048289
Provider Name (Legal Business Name): PRAIRIECORE DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KNUTH RD STE 106B
BOYNTON BEACH FL
33436-4635
US

IV. Provider business mailing address

200 KNUTH RD STE 106B
BOYNTON BEACH FL
33436-4635
US

V. Phone/Fax

Practice location:
  • Phone: 239-272-1666
  • Fax:
Mailing address:
  • Phone: 239-272-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JACKIE GUNTER
Title or Position: OWNER
Credential: ETC
Phone: 239-272-1666