Healthcare Provider Details

I. General information

NPI: 1396572855
Provider Name (Legal Business Name): COMPLETE MEDICAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 DUNLAWTON AVE
PORT ORANGE FL
32127-9226
US

IV. Provider business mailing address

735 DUNLAWTON AVE
PORT ORANGE FL
32127-9226
US

V. Phone/Fax

Practice location:
  • Phone: 386-301-4450
  • Fax: 386-872-4232
Mailing address:
  • Phone: 386-301-4450
  • Fax: 386-872-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID HEISE
Title or Position: OWNER
Credential: MD
Phone: 386-235-1489