Provider Demographics
NPI:1700962339
Name:COMPLETE CARE CENTER, PC
Entity Type:Organization
Organization Name:COMPLETE CARE CENTER, PC
Other - Org Name:HOLLY ROAD MEDICAL ASSOCIATES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:TINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-695-8011
Mailing Address - Street 1:8401 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1812
Mailing Address - Country:US
Mailing Address - Phone:810-695-8011
Mailing Address - Fax:810-695-8002
Practice Address - Street 1:8401 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1812
Practice Address - Country:US
Practice Address - Phone:810-695-8011
Practice Address - Fax:810-695-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006592207R00000X
MI4301048801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B54895Medicare ID - Type UnspecifiedMEDICARE