=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740200211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE MEDICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 36TH ST STE C
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-217-4422
-----------------------------------------------------
Fax | 772-217-4460
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 401
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32961-0401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-567-4336
-----------------------------------------------------
Fax | 772-567-4340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NICHOLAS A COPPOLA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 772-567-4336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS07348
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------