MEDICARE: JOHN COMPAGNO MD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1033322649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN COMPAGNO MD, INC

Provider Business Mailing Address
First Line	:	PO BOX 700
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-0700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 ALFRED NOBEL DR
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1805
Country	:	US
Telephone Number	:	510-662-5200
Fax Number	:	510-662-5240

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN COMPAGNO
Credential	:	M.D.
Telephone Number	:	510-662-5200

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	01/15/2008

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