Basic Information
| Provider Information | |||||||||
| NPI: | 1902298466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPASS COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1634 11TH ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403557102 | ||||||||
| FaxNumber: | 7403533083 | ||||||||
| Practice Location | |||||||||
| Address1: | 1634 11TH ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403557102 | ||||||||
| FaxNumber: | 7403533083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2015 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | KIRBY | ||||||||
| AuthorizedOfficialFirstName: | SUMMER | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7403511514 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 251S00000X | N | Agencies | Community/Behavioral Health | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 0120399 | 05 | OH | MEDICAID |