Provider Demographics
NPI:1922392422
Name:COMPASS CLINIC LLC
Entity Type:Organization
Organization Name:COMPASS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-210-1320
Mailing Address - Street 1:100 W GORE ST STE 406
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1049
Mailing Address - Country:US
Mailing Address - Phone:407-210-1320
Mailing Address - Fax:321-202-2583
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:SUITE 607
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:407-210-1320
Practice Address - Fax:321-202-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL930AMedicare PIN