Provider Demographics
NPI:1740200211
Name:COMPASSIONATE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:COMPASSIONATE MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-567-4336
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-0401
Mailing Address - Country:US
Mailing Address - Phone:772-567-4336
Mailing Address - Fax:772-567-4340
Practice Address - Street 1:1485 37TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6518
Practice Address - Country:US
Practice Address - Phone:772-567-4336
Practice Address - Fax:772-567-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS07348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8361Medicare ID - Type Unspecified