Provider Demographics
NPI:1477556645
Name:COMPLETE MEDICAL HOMECARE
Entity Type:Organization
Organization Name:COMPLETE MEDICAL HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BULTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-621-2010
Mailing Address - Street 1:14309 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-5210
Mailing Address - Country:US
Mailing Address - Phone:800-505-1625
Mailing Address - Fax:800-624-1666
Practice Address - Street 1:14309 W 95TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-5210
Practice Address - Country:US
Practice Address - Phone:800-505-1625
Practice Address - Fax:800-624-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO18288774332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
470505OtherBCBS OF KANSAS
MO625925102Medicaid
KS100445500AMedicaid
31805011OtherBCBS OF KANSAS CITY
KS4621800001Medicare NSC
31805011OtherBCBS OF KANSAS CITY