1447431598 NPI number — COMPTON HEALTHCARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447431598 NPI number — COMPTON HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPTON HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHILLIP D COMPTON II
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447431598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 674
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39566-0674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-896-6640
Provider Business Mailing Address Fax Number:
228-896-6641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 SECURITY SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39507-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-896-6640
Provider Business Practice Location Address Fax Number:
228-896-6641
Provider Enumeration Date:
11/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOBSON
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
228-896-6640

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  16438 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00121014 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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