Provider Demographics
NPI:1073117735
Name:COMPASSIONATE SPECIALTY CLINIC, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE SPECIALTY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:NGANG
Authorized Official - Last Name:ZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-502-7134
Mailing Address - Street 1:10319 WESTLAKE DR STE 193
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7831 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3338
Practice Address - Country:US
Practice Address - Phone:240-394-7786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone