MEDICARE: COMPLETE CARE MEDICAL SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1083963920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE MEDICAL SYSTEMS

Provider Business Mailing Address
First Line	:	4660 MARTIN LUTHER KING JR AVE SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4933
Country	:	US
Telephone Number	:	202-574-5136
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 MARTIN LUTHER KING JR AVE SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4933
Country	:	US
Telephone Number	:	202-574-5136
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT DUCKETT
Credential	:
Telephone Number	:	202-574-5136

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	09/06/2012

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Directions to “COMPLETE CARE MEDICAL SYSTEMS ” Practice Location

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