MEDICARE: COMPASS DIAGNOSTICS LLC

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1578337408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	7457 103RD ST STE 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-6775
Country	:	US
Telephone Number	:	904-219-2170
Fax Number	:	904-339-9418

Provider Business Practice Location Address
First Line	:	7457 103RD ST STE 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-6775
Country	:	US
Telephone Number	:	904-219-2170
Fax Number	:	904-339-9418

Authorized Official
Title or Position	:	OWNER
Name	:	NELSON CRUZ
Credential	:
Telephone Number	:	904-219-2170

Provider Enumeration Date	:	11/10/2023
Last Update Date	:	11/10/2023

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