Healthcare Provider Details

I. General information

NPI: 1417570664
Provider Name (Legal Business Name): COMPASS MEDICAL CENTER HEBER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 HIGHWAY 260
OVERGAARD AZ
85933
US

IV. Provider business mailing address

PO BOX 2340
OVERGAARD AZ
85933
US

V. Phone/Fax

Practice location:
  • Phone: 928-536-5525
  • Fax: 928-536-3735
Mailing address:
  • Phone: 928-536-5525
  • Fax: 928-536-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN JAMES WOODSIDE
Title or Position: OWNER
Credential: DC
Phone: 928-536-5525