Healthcare Provider Details

I. General information

NPI: 1932642733
Provider Name (Legal Business Name): COMPASSIONATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST
MATTHEWS MO
63867-8128
US

IV. Provider business mailing address

201 W MAIN ST
MATTHEWS MO
63867-8128
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-1514
  • Fax: 573-471-1517
Mailing address:
  • Phone: 573-471-1514
  • Fax: 573-471-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMELIA D LEDBETTER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 573-335-4715