1639887581 NPI number — COMPASS IMMUNO ONCOLOGY

Table of content: (NPI 1639887581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639887581 NPI number — COMPASS IMMUNO ONCOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASS IMMUNO ONCOLOGY
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:
Provider Other Organization Name Type Code:
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:
1639887581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CORREO VILLA
Provider Second Line Business Mailing Address:
AA-2 AVE TEGAS PMB 289
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00791-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LEGACY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
12 CALLE VICTORIA SUITE 22
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00971-4293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-266-9151
Provider Business Practice Location Address Fax Number:
787-520-7419
Provider Enumeration Date:
11/09/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRAYBILL
Authorized Official First Name:
CHELSIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE
Authorized Official Telephone Number:
787-424-9888

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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