Provider Demographics
NPI:1245200369
Name:COMPLETE MEDICAL CARE PA
Entity Type:Organization
Organization Name:COMPLETE MEDICAL CARE PA
Other - Org Name:COMPLETE MEDICAL CARE PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,
Authorized Official - Phone:361-884-1047
Mailing Address - Street 1:3138 S ALAMEDA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2531
Mailing Address - Country:US
Mailing Address - Phone:361-884-4131
Mailing Address - Fax:361-884-4171
Practice Address - Street 1:3138 S ALAMEDA ST
Practice Address - Street 2:SUITE A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2531
Practice Address - Country:US
Practice Address - Phone:361-884-4131
Practice Address - Fax:361-884-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0796526 01Medicaid
TX0796526 01Medicaid
TXG42681Medicare UPIN
TX00040FMedicare PIN