Provider Demographics
NPI:1295941243
Name:COMPLETE PATIENT SERVICES LLC
Entity type:Organization
Organization Name:COMPLETE PATIENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:STOUDENMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-460-0300
Mailing Address - Street 1:70161 HIGHWAY 59
Mailing Address - Street 2:SUITE C
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3706
Mailing Address - Country:US
Mailing Address - Phone:985-892-7775
Mailing Address - Fax:985-892-4230
Practice Address - Street 1:70161 HIGHWAY 59
Practice Address - Street 2:SUITE C
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3706
Practice Address - Country:US
Practice Address - Phone:985-892-7775
Practice Address - Fax:985-892-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA89101288332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1470988Medicaid
LA1202910003Medicare NSC