MEDICARE: COMPASS HEALTH, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1700426913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS HEALTH, INC

Provider Business Mailing Address
First Line	:	2310 N TRUMAN BLVD
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-1037
Country	:	US
Telephone Number	:	636-220-5397
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 N TRUMAN BLVD
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-1037
Country	:	US
Telephone Number	:	636-220-5397
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	TERESA L PORTER
Credential	:
Telephone Number	:	660-890-8156

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	07/04/2023

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