Provider Demographics
NPI:1154664332
Name:COMPASSIONATE CARE CENTER FOR SURGICAL EXCELLENCE
Entity type:Organization
Organization Name:COMPASSIONATE CARE CENTER FOR SURGICAL EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:K
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-238-0212
Mailing Address - Street 1:68 STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-1642
Mailing Address - Country:US
Mailing Address - Phone:304-238-0212
Mailing Address - Fax:304-238-0215
Practice Address - Street 1:68 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:OH
Practice Address - Zip Code:43912-1642
Practice Address - Country:US
Practice Address - Phone:304-238-0212
Practice Address - Fax:304-238-0215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201021401101261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical