| NPI | 1912670449 |
|---|---|
| Former Legal Business Name | PROACTIVE MD OK LLC |
| Entity Type | Organization |
| Authorized Contact | JAN HOPKINS Assoc. Ops Mrg 864-501-0751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2022-04-05 |