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General NPI Number Information
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NPI Number | 1679079669
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE FAMILY PRACTICE
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 713 1/2 W 27TH ST
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City | SCOTTSBLUFF
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State | NE
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Zip | 69361-4412
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Country | US
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Telephone | 308-633-2273
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Fax | 308-633-2276
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Provider Business Mailing Address
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Address Line | 713 1/2 W 27TH ST
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City | SCOTTSBLUFF
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State | NE
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Zip | 69361-4412
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Country | US
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Telephone | 308-633-2273
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Fax | 308-633-2276
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MRS. PEGGY LYNN SHEETS
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Credential |
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Telephone | 308-641-1262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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