Organization
COMPLETE LOCAL SPECIALTY CARE, INC
Active
Other names
CLSC
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTAL BRAY BA (ADMINISTRATOR)
(954) 418-1683
Entity
Organization
Contact information
Practice address
5355 LYONS RD, COCONUT CREEK, FL 33073-2825
(954) 570-9595
Mailing address
4855 W. HILLSBORO BLVD STE B2, COCONUT CREEK, FL 33073-4356
(954) 418-1683
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268799200
—
FL
01
—
74562
MEDICARE PTAN
FL
Enumeration date
09/27/2005
Last updated
01/19/2012
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