Basic Information
Provider Information | |||||||||
NPI: | 1982869749 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMPASS MEDICAL, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 COMPASS WAY | ||||||||
Address2: | SUITE 210 | ||||||||
City: | EAST BRIDGEWATER | ||||||||
State: | MA | ||||||||
PostalCode: | 023331465 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5083502350 | ||||||||
FaxNumber: | 5083502318 | ||||||||
Practice Location | |||||||||
Address1: | 1 COMPASS WAY | ||||||||
Address2: | SUITE 104 | ||||||||
City: | EAST BRIDGEWATER | ||||||||
State: | MA | ||||||||
PostalCode: | 023331465 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5083502181 | ||||||||
FaxNumber: | 5083502323 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/22/2008 | ||||||||
LastUpdateDate: | 07/22/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CLAIRMONT | ||||||||
AuthorizedOfficialFirstName: | GEORGE | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5083502350 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 2692 | MA | Y |   | Laboratories | Clinical Medical Laboratory |   |
No ID Information.