Provider Demographics
NPI:1710423918
Name:COMPASSIONATE CARDIOLOGY PC
Entity Type:Organization
Organization Name:COMPASSIONATE CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-817-3412
Mailing Address - Street 1:211 S CRAPO ST
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2961
Mailing Address - Country:US
Mailing Address - Phone:989-953-4188
Mailing Address - Fax:
Practice Address - Street 1:211 S CRAPO ST
Practice Address - Street 2:STE A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2961
Practice Address - Country:US
Practice Address - Phone:989-953-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC66266Medicaid
MIC66266Medicaid