NPIMap

Organization Active NPI

Pro-Care Family Health of Oklahoma , LLC

  • Family Medicine Physician
  • Poteau, OK
National Provider Identifier
1396234761
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRO-CARE FAMILY HEALTH OF OKLAHOMA , LLC
Practice address
1103 Dewey Ave
Poteau, OK 74953-4411
Phone
(918) 647-0670
Fax
(918) 647-0460
NPI assigned
May 1, 2018
Last updated
Aug 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chris Dooly
Title
Member
Phone
(918) 647-0670

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Medical Specialty Clinic/Center 261QM2500X NU
Podiatric Clinic/Center 261QP1100X NU
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

1103 Dewey Ave
Poteau, OK 74953-4411

Mailing address

PO Box 1278
Poteau, OK 74953-1278
Phone (918) 647-0670

Other practice location 1

2202 N Broadway St
Poteau, OK 74953-2000
Phone (918) 721-0140

Other practice location 2

215 N Main St
Hackett, AR 72937-8801
Phone (479) 255-6095

Other practice location 3

105 N Pocola Blvd Ste 2
Pocola, OK 74902-3101
Phone (918) 436-5001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181010002297 OK Part B Supplier - Clinic/Group Practice 1456603901 Receives reassigned benefits from 7 practitioners
Practice locations: Poteau, OK; Heavener, OK

National Provider Directory

National Provider Directory

Locations

105 N Pocola Blvd
Pocola, OK 74902
Phone (918) 436-5001

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1396234761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1278",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749531278",
            "telephone_number": "918-647-0670",
            "fax_number": "918-647-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 DEWEY AVE",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534411",
            "telephone_number": "918-647-0670",
            "fax_number": "918-647-0460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2202 N Broadway St",
            "address_purpose": "LOCATION",
            "city": "Poteau",
            "state": "OK",
            "postal_code": "749532000",
            "country_code": "US",
            "telephone_number": "918-721-0140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 N Main St",
            "address_purpose": "LOCATION",
            "city": "Hackett",
            "state": "AR",
            "postal_code": "729378801",
            "country_code": "US",
            "telephone_number": "479-255-6095",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 N Pocola Blvd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Pocola",
            "state": "OK",
            "postal_code": "749023101",
            "country_code": "US",
            "telephone_number": "918-436-5001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRO-CARE FAMILY HEALTH OF OKLAHOMA , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-01",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "DOOLY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "918-647-0670"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poteau, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.