Provider Demographics
NPI:1235394396
Name:COMPRECARE MEDICAL, LLC
Entity Type:Organization
Organization Name:COMPRECARE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTSHELER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:314-739-3990
Mailing Address - Street 1:3440 DE PAUL LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3545
Mailing Address - Country:US
Mailing Address - Phone:314-739-3990
Mailing Address - Fax:314-739-3924
Practice Address - Street 1:3440 DE PAUL LN
Practice Address - Street 2:SUITE 110
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3545
Practice Address - Country:US
Practice Address - Phone:314-739-3990
Practice Address - Fax:314-739-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODB5898OtherRR MEDICARE GROUP#
MODB5898OtherRR MEDICARE GROUP#