Provider Demographics
NPI:1982152906
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:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-939-7037
Mailing Address - Street 1:1413 HIGHWAY 17 S
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6040
Mailing Address - Country:US
Mailing Address - Phone:843-631-4656
Mailing Address - Fax:
Practice Address - Street 1:1413 HIGHWAY 17 S
Practice Address - Street 2:SUITE 1200
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6040
Practice Address - Country:US
Practice Address - Phone:843-631-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty