1639280571 NPI number — COMPLETE MEDICAL, INC

Table of content: (NPI 1639280571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639280571 NPI number — COMPLETE MEDICAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE MEDICAL, INC
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:
COMPLETE MEDICAL, INC.
Provider Other Organization Name Type Code:
4
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:
1639280571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SOUTHSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35901-5355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-549-0450
Provider Business Mailing Address Fax Number:
256-549-0340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SOUTHSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35901-5355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-549-0450
Provider Business Practice Location Address Fax Number:
256-549-0340
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HORN
Authorized Official First Name:
BUFFY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
256-478-6620

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  540 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009702530 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51525731 . This is a "BC/BS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".