Organization
MCH PROFESSIONAL CARE RADIOLOGY
Active
Organization
MCH PROFESSIONAL CARE RADIOLOGY
Active
Other names
ProCare
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP MALONE (OPERATIONS MANAGER)
(405) 321-8125
Entity
Organization
Contact information
Practice address
500 W 4TH ST, ODESSA, TX 79761-5001
(432) 640-2401
(432) 640-1031
Mailing address
PO BOX 704, INDIANAPOLIS, IN 46206-0704
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0069NZ
BLUE CROSS BLUE SHIELD
TX
05
—
188726701
—
TX
Enumeration date
08/31/2006
Last updated
03/24/2009
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