Healthcare Provider Details

I. General information

NPI: 1477556645
Provider Name (Legal Business Name): COMPLETE MEDICAL HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14309 W 95TH ST
LENEXA KS
66215-5210
US

IV. Provider business mailing address

14309 W 95TH ST
LENEXA KS
66215-5210
US

V. Phone/Fax

Practice location:
  • Phone: 800-505-1625
  • Fax: 800-624-1666
Mailing address:
  • Phone: 800-505-1625
  • Fax: 800-624-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number18288774
License Number StateMO

VIII. Authorized Official

Name: MRS. LORI BULTMAN
Title or Position: GENERAL MANAGER
Credential:
Phone: 816-621-2010