Provider Demographics
NPI:1013695626
Name:COMPASS POINTE MEDICAL PLLC
Entity Type:Organization
Organization Name:COMPASS POINTE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOETJE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:231-740-6370
Mailing Address - Street 1:116 W COLBY ST STE D
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1084
Mailing Address - Country:US
Mailing Address - Phone:231-740-6370
Mailing Address - Fax:
Practice Address - Street 1:116 W COLBY ST STE D
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1084
Practice Address - Country:US
Practice Address - Phone:231-292-1240
Practice Address - Fax:231-292-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty