Complete Well-Care Source LLC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Legal business name

COMPLETE WELL-CARE SOURCE LLC

Practice address

1320 Landsdown Dr
Salisbury, NC 28147-7373

Phone

(980) 330-3432

NPI assigned

Jul 10, 2020

Last updated

Jul 10, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Myra Vaughters WilsonNPI 1346879434

Title

Ceo

Phone

(336) 682-8968

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Complete Well-Care Source LLC Other name

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Myra Vaughters Wilson

  • Case Manager/Care Coordinator
  • Salisbury, NC
  • NPI 1346879434
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594339200000",
    "number": "1952929408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 LANDSDOWN DR",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281477373",
            "telephone_number": "980-330-3432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 LANDSDOWN DR",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281477373",
            "telephone_number": "980-330-3432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE WELL-CARE SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-10",
        "last_updated": "2020-07-10",
        "certification_date": "2020-07-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MYRA",
        "authorized_official_middle_name": "VAUGHTERS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-682-8968",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346879434",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "LAN",
            "affiliation": "N",
            "address_1": "1320 Landsdown Dr",
            "city": "Salisbury",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281477373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Complete Well-Care Source LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Case Manager/Care Coordinator in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Case Manager/Care Coordinator in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.