Provider Demographics
NPI:1639196710
Name:COMPLETE CARE CLINIC PLLC
Entity type:Organization
Organization Name:COMPLETE CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SATTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-882-6618
Mailing Address - Street 1:15 N 100 E
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2101
Mailing Address - Country:US
Mailing Address - Phone:435-882-6618
Mailing Address - Fax:435-843-3774
Practice Address - Street 1:15 N 100 E
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2101
Practice Address - Country:US
Practice Address - Phone:435-882-6618
Practice Address - Fax:435-843-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2807191205305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT261517430001Medicaid
UTG37625Medicare UPIN
UT005715601Medicare ID - Type Unspecified