Provider Demographics
NPI:1467698738
Name:COMPHRENSIVE MEDICAL CARE
Entity Type:Organization
Organization Name:COMPHRENSIVE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLYU
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-577-1264
Mailing Address - Street 1:1703 COUNTRY CLUB RD
Mailing Address - Street 2:#102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6008
Mailing Address - Country:US
Mailing Address - Phone:910-346-9500
Mailing Address - Fax:910-346-9516
Practice Address - Street 1:1703 COUNTRY CLUB RD
Practice Address - Street 2:#102
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6008
Practice Address - Country:US
Practice Address - Phone:910-346-9500
Practice Address - Fax:910-346-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty