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General NPI Number Information
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NPI Number | 1619249729
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Entity Type | Organization
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Legal Business Name | PROCARE MEDICAL SERVICES
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Dates
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Enumeration Date | 02/04/2012
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 10701 CORPORATE DR 193
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City | STAFFORD
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State | TX
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Zip | 77477-4096
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Country | US
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Telephone | 281-903-7474
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Fax | 832-500-4095
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Provider Business Mailing Address
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Address Line | 10701 CORPORATE DR 193
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City | STAFFORD
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State | TX
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Zip | 77477-4096
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Country | US
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Telephone | 281-903-7474
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Fax | 832-500-4095
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. EMAIDO ETUKUDOH HAILEY
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Credential |
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Telephone | 281-903-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 014831
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License Number State | TX
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