Provider Demographics
NPI:1710621792
Name:COMPLETE MEDICAL CARE CENTER
Entity Type:Organization
Organization Name:COMPLETE MEDICAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:409-832-6129
Mailing Address - Street 1:PO BOX 20025
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-0025
Mailing Address - Country:US
Mailing Address - Phone:409-454-8773
Mailing Address - Fax:409-860-8150
Practice Address - Street 1:3480 FANNIN ST STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3804
Practice Address - Country:US
Practice Address - Phone:409-832-6129
Practice Address - Fax:409-860-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty