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General NPI Number Information
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NPI Number | 1366425746
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Entity Type | Organization
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Legal Business Name | PROCARE PROSTHETICS & ORTHOTICS, INC.
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 1050 N FLOWOOD DR STE C1
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City | FLOWOOD
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State | MS
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Zip | 39232-9738
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Country | US
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Telephone | 601-664-7004
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Fax | 601-664-7099
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Provider Business Mailing Address
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Address Line | 1050 N FLOWOOD DR STE C1
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City | FLOWOOD
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State | MS
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Zip | 39232-9738
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Country | US
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Telephone | 601-664-7004
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Fax | 601-664-7099
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN BRET LEE
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Credential | CPO
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Telephone | 601-664-7004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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