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General NPI Number Information
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NPI Number | 1609700079
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Entity Type | Organization
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Legal Business Name | PRO-CARE FAMILY HEALTH OF OKLAHOMA , LLC
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 1103 DEWEY AVE
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City | POTEAU
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State | OK
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Zip | 74953-4411
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Country | US
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Telephone | 918-649-3777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1278
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City | POTEAU
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State | OK
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Zip | 74953-1278
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Country | US
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Telephone | 918-649-3777
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | EVELYN MARIE TUSTIN
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Credential |
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Telephone | 918-647-0670
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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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