Provider Demographics
NPI:1932453065
Name:COMPASS IMAGING LLC
Entity Type:Organization
Organization Name:COMPASS IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-314-7226
Mailing Address - Street 1:3200 MALLETT RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 MALLETT RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-9305
Practice Address - Country:US
Practice Address - Phone:228-314-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory