Healthcare Provider Details

I. General information

NPI: 1275670747
Provider Name (Legal Business Name): COMPASS HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N PROVIDENCE RD
COLUMBIA MO
65203-4365
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 573-277-7899
  • Fax: 573-442-5208
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TERESA L PORTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 660-890-8156