=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821021650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASS MEDICAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 299 HIGHWAY 51 SUITE F2
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-856-2290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 299 HIGHWAY 51 SUITE F2
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-856-2290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN DEBORAH ANDREWS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 601-856-2290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 14224
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------