MEDICARE: COMPASSIONATE CARE FAMILY MEDICINE 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	207Q00000X	Family Medicine Physician	35065672	OH

General Provider Information

NPI Number	:	1740468917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE FAMILY MEDICINE INC

Provider Business Mailing Address
First Line	:	1475 LEXINGTON AVE
Second Line	:	SUITE B
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2629
Country	:	US
Telephone Number	:	419-775-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 LEXINGTON AVE
Second Line	:	SUITE B
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2629
Country	:	US
Telephone Number	:	419-775-7780
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DEBORAH R COWDEN
Credential	:
Telephone Number	:	419-775-7780

Provider Enumeration Date	:	02/09/2008
Last Update Date	:	02/09/2008

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