Provider Demographics
NPI:1104987270
Name:COMPESS HEALTH CARE
Entity type:Organization
Organization Name:COMPESS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMMONS-CLEMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-323-7700
Mailing Address - Street 1:1900 E NORTHERN PKWY
Mailing Address - Street 2:#201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2110
Mailing Address - Country:US
Mailing Address - Phone:410-323-7700
Mailing Address - Fax:410-323-0974
Practice Address - Street 1:1900 E NORTHERN PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2113
Practice Address - Country:US
Practice Address - Phone:410-323-7700
Practice Address - Fax:410-323-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD098200800Medicaid
MD2268Medicare PIN