MEDICARE: C3 POWERED BY ABSOLUTECARE, LLC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285109520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C3 POWERED BY ABSOLUTECARE, LLC

Provider Business Mailing Address
First Line	:	2140 PEACHTREE RD NW STE 232
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1314
Country	:	US
Telephone Number	:	404-231-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 S PACA ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-1735
Country	:	US
Telephone Number	:	410-328-3117
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	THOMAS J TRENTLY
Credential	:
Telephone Number	:	443-738-0281

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	02/03/2021

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