Basic Information
| Provider Information | |||||||||
| NPI: | 1740200211 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPASSIONATE MEDICAL CENTER INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 401 | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329610401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725674336 | ||||||||
| FaxNumber: | 7725674340 | ||||||||
| Practice Location | |||||||||
| Address1: | 1485 37TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329606518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725674336 | ||||||||
| FaxNumber: | 7725674340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | COPPOLA | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7725674336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS07348 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.