MEDICARE: COMPASS DIAGNOSTICS, LLC

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	251B00000X	Case Management Agency	35672998	TX

General Provider Information

NPI Number	:	1740616861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 270985
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77277-0985
Country	:	US
Telephone Number	:	832-359-8441
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 S RICE AVE APT 1324
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2147
Country	:	US
Telephone Number	:	832-359-8441
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISA KIM THAI
Credential	:
Telephone Number	:	832-359-8441

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/20/2013

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