Provider Demographics
NPI:1811387285
Name:COMPASS MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:COMPASS MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODSIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-536-5525
Mailing Address - Street 1:1300 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5661
Mailing Address - Country:US
Mailing Address - Phone:928-536-5525
Mailing Address - Fax:928-484-6070
Practice Address - Street 1:1300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5661
Practice Address - Country:US
Practice Address - Phone:928-536-5525
Practice Address - Fax:928-484-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7221208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty