MEDICARE: COMPLETE CARE MEDICAL GROUP

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	111N00000X	Chiropractor	2496	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260662270003	OTHER	OK	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1487848305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	9220 S PENN AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6909
Country	:	US
Telephone Number	:	405-691-2838
Fax Number	:	405-692-8807

Provider Business Practice Location Address
First Line	:	9220 S PENN AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6909
Country	:	US
Telephone Number	:	405-691-2838
Fax Number	:	405-692-8807

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. JAMES V PERTREE
Credential	:	D.C.
Telephone Number	:	405-691-2838

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	09/04/2007

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Directions to “COMPLETE CARE MEDICAL GROUP ” Practice Location

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