Provider Demographics
NPI:1568477115
Name:COMPLETE CARE MEDICAL, INC.
Entity Type:Organization
Organization Name:COMPLETE CARE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCTS MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-286-5044
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-0208
Mailing Address - Country:US
Mailing Address - Phone:580-286-5044
Mailing Address - Fax:580-286-5063
Practice Address - Street 1:110 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-4636
Practice Address - Country:US
Practice Address - Phone:580-286-5044
Practice Address - Fax:580-286-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0128332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherFEDERAL TAX ID
OK0224830001Medicare ID - Type Unspecified