Healthcare Provider Details

I. General information

NPI: 1083193528
Provider Name (Legal Business Name): COMPASS TREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 5TH ST STE 100
AMES IA
50010-6071
US

IV. Provider business mailing address

600 5TH ST STE 100
AMES IA
50010-6071
US

V. Phone/Fax

Practice location:
  • Phone: 515-233-3971
  • Fax: 877-522-5014
Mailing address:
  • Phone: 515-233-3971
  • Fax: 877-522-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35329
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001300
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA127170
License Number StateIA

VIII. Authorized Official

Name: MRS. KRISTINE JANAE KATZ
Title or Position: BILLING MANAGER
Credential:
Phone: 515-233-3971