Healthcare Provider Details

I. General information

NPI: 1225032659
Provider Name (Legal Business Name): COMPLETE PATIENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 04/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 BOULEVARD PARK N
MOBILE AL
36609-3422
US

IV. Provider business mailing address

4333 BOULEVARD PARK N
MOBILE AL
36609-3422
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-0300
  • Fax: 251-460-0304
Mailing address:
  • Phone: 251-460-0300
  • Fax: 251-460-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4900 41002
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2005-009446
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number111212
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number200547
License Number StateAL

VIII. Authorized Official

Name: MRS. DEBRA G STOUDENMIRE
Title or Position: OWNER
Credential:
Phone: 251-460-0300