Provider Demographics
NPI:1679614150
Name:PROVIDER CARE INC.
Entity type:Organization
Organization Name:PROVIDER CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RON
Authorized Official - Last Name:GUINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-8107
Mailing Address - Street 1:7505 PINES RD
Mailing Address - Street 2:SUITE 1190
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3929
Mailing Address - Country:US
Mailing Address - Phone:318-688-8107
Mailing Address - Fax:318-686-0041
Practice Address - Street 1:7505 PINES RD
Practice Address - Street 2:SUITE 1190
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3929
Practice Address - Country:US
Practice Address - Phone:318-688-8107
Practice Address - Fax:318-686-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS015065287332B00000X
MS019017722332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440426Medicaid
MS1124480001Medicare NSC