Provider Demographics
NPI:1750377453
Name:COMPLETE LOCAL SPECIALTY CARE, INC
Entity type:Organization
Organization Name:COMPLETE LOCAL SPECIALTY CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-418-1683
Mailing Address - Street 1:4855 W HILLSBORO BLVD
Mailing Address - Street 2:STE B2
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-418-1683
Mailing Address - Fax:954-418-1698
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD
Practice Address - Street 2:STE 301
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-458-2572
Practice Address - Fax:954-354-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262408700Medicaid
FL21376Medicare UPIN
FL262408700Medicaid