Provider Demographics
NPI:1144214974
Name:COMPASSIONATE CARE LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE LLC
Other - Org Name:FAMILY PREFERENCE HEALTH CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:573-471-1514
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:MO
Mailing Address - Zip Code:63867-0358
Mailing Address - Country:US
Mailing Address - Phone:573-471-1514
Mailing Address - Fax:573-471-1517
Practice Address - Street 1:201 WEST MAIN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:MO
Practice Address - Zip Code:63867
Practice Address - Country:US
Practice Address - Phone:573-471-1514
Practice Address - Fax:573-471-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014714OtherMEDICARE PART B
MO268944Medicare Oscar/Certification