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General NPI Number Information
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NPI Number | 1437991908
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Entity Type | Organization
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Legal Business Name | PROCARE HEALING CENTERS, LLC
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 3501 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-2138
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Country | US
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Telephone | 866-306-4461
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Fax | 405-300-1336
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Provider Business Mailing Address
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Address Line | 3501 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-2138
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Country | US
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Telephone | 866-306-4461
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Fax | 405-300-1336
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRENTON STILLWELL
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Credential |
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Telephone | 866-306-4461
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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