Healthcare Provider Details

I. General information

NPI: 1457030397
Provider Name (Legal Business Name): COMPLETE CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 E HINES ST
REPUBLIC MO
65738-1277
US

IV. Provider business mailing address

1173 E HINES ST
REPUBLIC MO
65738-1277
US

V. Phone/Fax

Practice location:
  • Phone: 417-735-0055
  • Fax:
Mailing address:
  • Phone: 417-735-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE MCCLANAHAN
Title or Position: OWNER
Credential:
Phone: 417-735-0055