Provider Demographics
NPI:1093139040
Name:COMPLETE HEALTH URGICARE, INC
Entity Type:Organization
Organization Name:COMPLETE HEALTH URGICARE, INC
Other - Org Name:COMPLETE HEALTH URGENT CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-471-2273
Mailing Address - Street 1:6504 BIG OAK DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-7812
Mailing Address - Country:US
Mailing Address - Phone:228-471-2273
Mailing Address - Fax:
Practice Address - Street 1:4211 HOSPITAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5320
Practice Address - Country:US
Practice Address - Phone:228-471-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPA00445OtherMS BOARD OF MEDICAL LICENSURE - PHYSICIAN ASSISTANT LICENSE