Provider Demographics
NPI:1104270677
Name:COMPLETE FAMILY CARE CENTER, LLC
Entity type:Organization
Organization Name:COMPLETE FAMILY CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-444-5218
Mailing Address - Street 1:600 WHITNEY RANCH DR
Mailing Address - Street 2:SUITE #B-11
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2611
Mailing Address - Country:US
Mailing Address - Phone:702-558-6366
Mailing Address - Fax:702-558-6364
Practice Address - Street 1:600 WHITNEY RANCH DR
Practice Address - Street 2:SUITE #B-11
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2611
Practice Address - Country:US
Practice Address - Phone:702-558-6366
Practice Address - Fax:702-558-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV973DL207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1558317354Medicaid
NV973DLOtherMEDICAL LIC
NVFP153YMedicare UPIN