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General NPI Number Information
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NPI Number | 1225479959
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Entity Type | Organization
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Legal Business Name | PRO HEALTHCARE LLC
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 1420 VALWOOD PKWY SUITE NO. 20-170A
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City | CARROLLTON
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State | TX
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Zip | 75006-8312
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Country | US
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Telephone | 972-584-7616
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Fax | 214-853-5364
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Provider Business Mailing Address
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Address Line | 820 S MACARTHUR BLVD SUITE#105-281
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City | COPPELL
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State | TX
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Zip | 75019-4216
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Country | US
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Telephone | 972-584-7616
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Fax | 214-853-5364
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Authorized Official
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Title or Position | ADULT CLINICAL NURSE SPECIALIST
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Name | FURQAN KHAN
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Credential | APRN
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Telephone | 972-584-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P1483
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 696580
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License Number State | TX
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