Provider Demographics
NPI:1093812224
Name:COMPASS FAMILY MEDICINE,PA
Entity Type:Organization
Organization Name:COMPASS FAMILY MEDICINE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-276-4860
Mailing Address - Street 1:2605 KINARD ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2966
Mailing Address - Country:US
Mailing Address - Phone:803-276-4860
Mailing Address - Fax:803-276-2812
Practice Address - Street 1:2605 KINARD STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2909
Practice Address - Country:US
Practice Address - Phone:803-276-4860
Practice Address - Fax:803-276-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty