Provider Demographics
NPI:1922754290
Name:COMPASSION PEDIATRICS OF WAYLAND
Entity Type:Organization
Organization Name:COMPASSION PEDIATRICS OF WAYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-456-4591
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41666-0293
Mailing Address - Country:US
Mailing Address - Phone:606-230-2255
Mailing Address - Fax:
Practice Address - Street 1:2643 KING KELLY COLEMAN HWY
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:KY
Practice Address - Zip Code:41666
Practice Address - Country:US
Practice Address - Phone:606-230-2255
Practice Address - Fax:606-437-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health