Provider Demographics
NPI:1578705216
Name:CHK COMPASSION CARE LLC
Entity Type:Organization
Organization Name:CHK COMPASSION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HUDSON-KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-355-5300
Mailing Address - Street 1:2880 NETHERTON DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136
Mailing Address - Country:US
Mailing Address - Phone:314-355-5300
Mailing Address - Fax:314-355-1177
Practice Address - Street 1:2880 NETHERTON DRIVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-355-5300
Practice Address - Fax:314-355-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101365261QP2300X
MOMD101365261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherFEIN
F31392Medicare UPIN