Healthcare Provider Details

I. General information

NPI: 1669809554
Provider Name (Legal Business Name): COMPASS HEALTHCARE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD
LANSING MI
48912-3753
US

IV. Provider business mailing address

2175 COOLIDGE RD
EAST LANSING MI
48823-1379
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-0128
  • Fax: 517-487-2639
Mailing address:
  • Phone: 517-487-0128
  • Fax: 517-487-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BETH NATHAN
Title or Position: MANAGER
Credential:
Phone: 517-487-0128