Provider Demographics
NPI:1225032659
Name:COMPLETE PATIENT SERVICES LLC
Entity Type:Organization
Organization Name:COMPLETE PATIENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:STOUDENMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-460-0300
Mailing Address - Street 1:4333 BOULEVARD PARK N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3422
Mailing Address - Country:US
Mailing Address - Phone:251-460-0300
Mailing Address - Fax:251-460-0304
Practice Address - Street 1:4333 BOULEVARD PARK N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3422
Practice Address - Country:US
Practice Address - Phone:251-460-0300
Practice Address - Fax:251-460-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4900 41002332B00000X
AL2005-009446332B00000X
AL111212333600000X
AL200547333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002966Medicaid
AL009927290Medicaid
ME00440573Medicaid
AL009927290Medicaid