| Proactive Healthcare Services Llc | |
|
7023 Corner Creek Way Glenn Dale MD 20769-9472 | |
| (227) 218-8737 | |
| Not Available |
| Full Name | Proactive Healthcare Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7023 Corner Creek Way, Glenn Dale, Maryland |
| Authorized Official Name and Position | Israel Ogunsola (PRESIDENT) |
| Authorized Official Contact | 2272188737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Healthcare Services Llc 7023 Corner Creek Way Glenn Dale MD 20769-9472 Ph: (227) 218-8737 | Proactive Healthcare Services Llc 7023 Corner Creek Way Glenn Dale MD 20769-9472 Ph: (227) 218-8737 |
| NPI Number | 1982459335 |
|---|---|
| Provider Enumeration Date | 04/19/2024 |
| Last Update Date | 04/19/2024 |
| Certification Date | 04/19/2024 |
| Medicare PECOS PAC ID | 1557803780 |
|---|---|
| Medicare Enrollment ID | O20240604000551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982459335 | NPI | - | NPPES |
| Provider Name | Israel Ogunsola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164148367 PECOS PAC ID: 3971959982 Enrollment ID: I20240604000739 |
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