Healthcare Provider Details

I. General information

NPI: 1831160134
Provider Name (Legal Business Name): PROFESSIONAL PROVIDER CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N WALNUT ST
SALLISAW OK
74955-4438
US

IV. Provider business mailing address

103 N WALNUT ST
SALLISAW OK
74955-4438
US

V. Phone/Fax

Practice location:
  • Phone: 918-776-9400
  • Fax: 918-776-9200
Mailing address:
  • Phone: 918-776-9400
  • Fax: 918-776-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DARREN F GIRDNER
Title or Position: CEO
Credential:
Phone: 918-776-9400