Provider Demographics
NPI:1508235144
Name:COMPCARE LLC
Entity Type:Organization
Organization Name:COMPCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-706-0174
Mailing Address - Street 1:2111 E HIGHLAND AVE
Mailing Address - Street 2:SUITE B425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4741
Mailing Address - Country:US
Mailing Address - Phone:480-688-7491
Mailing Address - Fax:480-706-0117
Practice Address - Street 1:2111 E HIGHLAND AVE
Practice Address - Street 2:SUITE B425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4741
Practice Address - Country:US
Practice Address - Phone:480-688-7491
Practice Address - Fax:480-706-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherEIN