Provider Demographics
NPI:1467147249
Name:COMPASS MEDICAL CENTER CLIFTON
Entity Type:Organization
Organization Name:COMPASS MEDICAL CENTER CLIFTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-536-5525
Mailing Address - Street 1:3229 I-70 BUSINESS LOOP
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7682
Mailing Address - Country:US
Mailing Address - Phone:970-424-5223
Mailing Address - Fax:970-628-9965
Practice Address - Street 1:3229 I-70 BUSINESS LOOP
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:CO
Practice Address - Zip Code:81520-7682
Practice Address - Country:US
Practice Address - Phone:970-424-5223
Practice Address - Fax:970-628-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty