Healthcare Provider Details

I. General information

NPI: 1003235094
Provider Name (Legal Business Name): COMPLEX SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 STEELE STATION RD
RAINBOW CITY AL
35906-8722
US

IV. Provider business mailing address

PO BOX 1941
GADSDEN AL
35902-1941
US

V. Phone/Fax

Practice location:
  • Phone: 256-456-5811
  • Fax: 256-485-0753
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberPM.163
License Number StateAL

VIII. Authorized Official

Name: DAVID LYLE SHEHI
Title or Position: PRESIDENT
Credential:
Phone: 256-456-5811