1578255311 NPI number — COMPLETE COMMUNITY CARE PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578255311 NPI number — COMPLETE COMMUNITY CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE COMMUNITY CARE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578255311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8002 FM 1464 RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77407-8087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-400-2733
Provider Business Mailing Address Fax Number:
832-400-2734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8002 FM 1464 RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77407-8087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-432-5576
Provider Business Practice Location Address Fax Number:
832-400-2734
Provider Enumeration Date:
05/22/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALLICK
Authorized Official First Name:
SALMAN
Authorized Official Middle Name:
RASHEED
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
612-273-3000

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)