Healthcare Provider Details

I. General information

NPI: 1700010097
Provider Name (Legal Business Name): PROCARE MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S93W31636 GENA DR
MUKWONAGO WI
53149-8273
US

IV. Provider business mailing address

S93W31636 GENA DR
MUKWONAGO WI
53149-8273
US

V. Phone/Fax

Practice location:
  • Phone: 414-254-4020
  • Fax:
Mailing address:
  • Phone: 414-254-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD H LAMBERT JR.
Title or Position: OWNER
Credential:
Phone: 414-254-4020