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General NPI Number Information
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NPI Number | 1083963920
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE MEDICAL SYSTEMS
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 4660 MARTIN LUTHER KING JR AVE SW
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City | WASHINGTON
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State | DC
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Zip | 20032-4933
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Country | US
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Telephone | 202-574-5136
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Fax |
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Provider Business Mailing Address
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Address Line | 4660 MARTIN LUTHER KING JR AVE SW
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City | WASHINGTON
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State | DC
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Zip | 20032-4933
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Country | US
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Telephone | 202-574-5136
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT DUCKETT
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Credential |
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Telephone | 202-574-5136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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