Healthcare Provider Details

I. General information

NPI: 1760453799
Provider Name (Legal Business Name): COMPASS IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14245 DEDEAUX RD
GULFPORT MS
39503-3369
US

IV. Provider business mailing address

PO BOX 2819
GULFPORT MS
39505-2819
US

V. Phone/Fax

Practice location:
  • Phone: 228-314-7226
  • Fax: 228-314-7227
Mailing address:
  • Phone: 228-314-7226
  • Fax: 228-314-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. LESLIE C VAUGHN
Title or Position: ADMINISTRATOR
Credential:
Phone: 228-314-7226