Healthcare Provider Details

I. General information

NPI: 1124583869
Provider Name (Legal Business Name): COMPASS HEALTHCARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SAGINAW ST
EAST LANSING MI
48823-2740
US

IV. Provider business mailing address

250 E SAGINAW ST
EAST LANSING MI
48823-2740
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-3080
  • Fax:
Mailing address:
  • Phone: 517-337-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID L. CORTEVILLE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 517-999-5900