Healthcare Provider Details

I. General information

NPI: 1710380688
Provider Name (Legal Business Name): COMPASS HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W BROADWAY ST
EL DORADO SPRINGS MO
64744-1133
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 660-890-8186
  • Fax:
Mailing address:
  • Phone: 660-890-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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