Provider Demographics
NPI:1164982443
Name:COMPASSION CARE CLINIC
Entity Type:Organization
Organization Name:COMPASSION CARE CLINIC
Other - Org Name:STACEY MICHELIN
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:806-626-3760
Mailing Address - Street 1:2443 OLD RUSSELLVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-542-9010
Mailing Address - Fax:844-557-9435
Practice Address - Street 1:2443 OLD RUSSELLVILLE PIKE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-542-9010
Practice Address - Fax:844-557-9435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ044516Medicaid