Healthcare Provider Details

I. General information

NPI: 1134531999
Provider Name (Legal Business Name): COMPASSIONATE CARE OF NC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 CHURCH RD
BOONE NC
28607-8332
US

IV. Provider business mailing address

345 DEERFIELD RD
BOONE NC
28607-5009
US

V. Phone/Fax

Practice location:
  • Phone: 828-963-9400
  • Fax: 828-963-1973
Mailing address:
  • Phone: 828-355-3365
  • Fax: 828-264-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005-00426
License Number StateNC

VIII. Authorized Official

Name: ELIZABETH SUDDERTH
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 828-355-3365