Provider Demographics
NPI:1134531999
Name:COMPASSIONATE CARE OF NC, P.A.
Entity type:Organization
Organization Name:COMPASSIONATE CARE OF NC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDDERTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-355-3365
Mailing Address - Street 1:345 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5009
Mailing Address - Country:US
Mailing Address - Phone:828-355-3365
Mailing Address - Fax:828-264-0543
Practice Address - Street 1:520 CHURCH RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8332
Practice Address - Country:US
Practice Address - Phone:828-963-9400
Practice Address - Fax:828-963-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty