MEDICARE: COMPLETE CARE MEDICAL CTR 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1801054010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE MEDICAL CTR LLC

Provider Business Mailing Address
First Line	:	3611 BRANCH AVE
Second Line	:	STE 106
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1242
Country	:	US
Telephone Number	:	301-316-2009
Fax Number	:	301-316-2115

Provider Business Practice Location Address
First Line	:	4660 MARTIN LUTHER KING JR AVE SW
Second Line	:	#A3
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4933
Country	:	US
Telephone Number	:	202-574-5136
Fax Number	:	202-563-5387

Authorized Official
Title or Position	:	OPERATING MANAGER
Name	:	MS. ANNA M THOMPSON
Credential	:
Telephone Number	:	301-316-2009

Provider Enumeration Date	:	05/26/2008
Last Update Date	:	11/03/2016

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