Provider Demographics
NPI:1710013669
Name:COMPLETE FAMILY MEDICINE, P.A
Entity Type:Organization
Organization Name:COMPLETE FAMILY MEDICINE, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMODA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOHAPATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-934-0555
Mailing Address - Street 1:419 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3201
Mailing Address - Country:US
Mailing Address - Phone:806-934-0555
Mailing Address - Fax:806-935-4600
Practice Address - Street 1:419 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3201
Practice Address - Country:US
Practice Address - Phone:806-934-0555
Practice Address - Fax:806-935-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty