Provider Demographics
NPI:1720371628
Name:COMPREHENSIVE CARE CLINICAN PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE CLINICAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:919-553-4404
Mailing Address - Street 1:2076 NC HIGHWAY 42 W
Mailing Address - Street 2:STE 240
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5302
Mailing Address - Country:US
Mailing Address - Phone:919-553-4150
Mailing Address - Fax:
Practice Address - Street 1:2076 NC HIGHWAY 42 W
Practice Address - Street 2:STE 240
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5302
Practice Address - Country:US
Practice Address - Phone:919-553-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001310363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty