Provider Demographics
NPI:1982151577
Name:COMPLETE CARE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:COMPLETE CARE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-823-7707
Mailing Address - Street 1:41 PEACH GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MONTROSS
Mailing Address - State:VA
Mailing Address - Zip Code:22520-2756
Mailing Address - Country:US
Mailing Address - Phone:804-410-3322
Mailing Address - Fax:804-627-0010
Practice Address - Street 1:41 PEACH GROVE LN
Practice Address - Street 2:
Practice Address - City:MONTROSS
Practice Address - State:VA
Practice Address - Zip Code:22520-2756
Practice Address - Country:US
Practice Address - Phone:804-410-3322
Practice Address - Fax:804-627-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236987207N00000X
VA010300694213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty