1821021650 NPI number — COMPASS MEDICAL, LLC

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 1821021650 NPI number — COMPASS MEDICAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASS MEDICAL, LLC
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:
COMPASS FAMILY MEDICINE
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:
1821021650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 HIGHWAY 51
Provider Second Line Business Mailing Address:
SUITE F2
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39157-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-856-2290
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299 HIGHWAY 51
Provider Second Line Business Practice Location Address:
SUITE F2
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-856-2290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREWS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
DEBORAH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
601-856-2290

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  14224 , 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: 0123510 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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