MEDICARE: COMPLETE CARE CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1255150819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	103 N OLD WILDERNESS RD
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-9057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 N OLD WILDERNESS RD
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-9057
Country	:	US
Telephone Number	:	417-576-0643
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEVE MCCLANAHAN
Credential	:
Telephone Number	:	417-576-0643

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	01/15/2026

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