Provider Demographics
NPI:1760874176
Name:COMPASSIONATE CARE PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-373-2535
Mailing Address - Street 1:6285 CHAUCER VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3575
Mailing Address - Country:US
Mailing Address - Phone:985-373-2535
Mailing Address - Fax:877-476-7801
Practice Address - Street 1:2159 S MCKENZIE ST
Practice Address - Street 2:SUITE 233
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1752
Practice Address - Country:US
Practice Address - Phone:985-373-2535
Practice Address - Fax:877-476-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-22
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty