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General NPI Number Information
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NPI Number | 1235800335
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Entity Type | Organization
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Legal Business Name | PROPHYLAXIS HEALTHCARE LLC
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 211 S MILL ST
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City | PRYOR
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State | OK
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Zip | 74361-5221
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Country | US
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Telephone | 918-825-3777
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Fax | 918-825-3776
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Provider Business Mailing Address
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Address Line | PO BOX 334
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City | BIXBY
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State | OK
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Zip | 74008-0334
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Country | US
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Telephone | 918-970-2886
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BERT SANCHEZ
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Credential |
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Telephone | 479-263-2690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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