Provider Demographics
NPI:1841364932
Name:COMPASSIONATE CARE, LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:BUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:816-279-4882
Mailing Address - Street 1:PO BOX 4944
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4900
Mailing Address - Country:US
Mailing Address - Phone:816-279-4882
Mailing Address - Fax:816-279-4008
Practice Address - Street 1:3949 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3649
Practice Address - Country:US
Practice Address - Phone:816-279-4882
Practice Address - Fax:816-279-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
KS05-32172207Q00000X
MO2000172096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000F086Medicare PIN
MOH29279Medicare UPIN
H29279Medicare UPIN