Basic Information
| Provider Information | |||||||||
| NPI: | 1730625104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMPASS HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 COMMUNITY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647358804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608908186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 PROGRESS PKWY | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630802359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608908186 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2017 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | PORTER | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING/CONTRACTING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6608908186 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.