Healthcare Provider Details

I. General information

NPI: 1801288600
Provider Name (Legal Business Name): COMPASS MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S MAIN ST STE A
SNOWFLAKE AZ
85937-5661
US

IV. Provider business mailing address

1300 S MAIN ST STE A
SNOWFLAKE AZ
85937-5661
US

V. Phone/Fax

Practice location:
  • Phone: 928-536-5525
  • Fax: 928-536-3010
Mailing address:
  • Phone: 928-536-5525
  • Fax: 928-536-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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