Provider Demographics
NPI:1043754708
Name:COMPASSUS OP OF VIRGINIA LLC
Entity Type:Organization
Organization Name:COMPASSUS OP OF VIRGINIA LLC
Other - Org Name:COMPASSUS - RESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-224-8028
Mailing Address - Street 1:10 CADILLAC DRIVE
Mailing Address - Street 2:STE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3432
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:12018 SUNRISE VALLEY DR
Practice Address - Street 2:STE 400
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3432
Practice Address - Country:US
Practice Address - Phone:571-262-5200
Practice Address - Fax:571-521-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
155151Medicare Oscar/Certification