Provider Demographics
NPI:1043216914
Name:COMPASSION INC., PAIN AND PALLIATIVE SVCS.
Entity Type:Organization
Organization Name:COMPASSION INC., PAIN AND PALLIATIVE SVCS.
Other - Org Name:EAST AVENUE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LILLY
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-475-7535
Mailing Address - Street 1:405 TALLMADGE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3342
Mailing Address - Country:US
Mailing Address - Phone:330-475-7535
Mailing Address - Fax:330-848-2332
Practice Address - Street 1:405 TALLMADGE RD
Practice Address - Street 2:STE 120
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3342
Practice Address - Country:US
Practice Address - Phone:330-475-7535
Practice Address - Fax:330-848-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00051741OtherRAILROAD MEDICARE GROUP
OH729280OtherBCHP ORGANIZATION ID
OHP00051741OtherRAILROAD MEDICARE GROUP
OH=========00OtherBWC GROUP NUMER