Provider Demographics
NPI:1821021650
Name:COMPASS MEDICAL, LLC
Entity Type:Organization
Organization Name:COMPASS MEDICAL, LLC
Other - Org Name:COMPASS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DEBORAH
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-856-2290
Mailing Address - Street 1:299 HIGHWAY 51
Mailing Address - Street 2:SUITE F2
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3424
Mailing Address - Country:US
Mailing Address - Phone:601-856-2290
Mailing Address - Fax:
Practice Address - Street 1:299 HIGHWAY 51
Practice Address - Street 2:SUITE F2
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3424
Practice Address - Country:US
Practice Address - Phone:601-856-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0123510Medicaid
A78818Medicare UPIN