Provider Demographics
NPI:1063556926
Name:COMPLETE CARE MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:COMPLETE CARE MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:IFEDIBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-929-0565
Mailing Address - Street 1:1300 BESSEMER RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208-4326
Mailing Address - Country:US
Mailing Address - Phone:205-929-0565
Mailing Address - Fax:205-929-0564
Practice Address - Street 1:1300 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-4326
Practice Address - Country:US
Practice Address - Phone:205-929-0565
Practice Address - Fax:205-929-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19014261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529921350Medicaid