1578255311 NPI number — COMPLETE COMMUNITY CARE PLLC

Table of content: (NPI 1578255311)

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:
05/13/2024
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: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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