Provider Demographics
NPI:1194276303
Name:COMPASSIONATE CARE CLINIC. LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE CLINIC. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLIEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-269-3870
Mailing Address - Street 1:218 S THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5330
Mailing Address - Country:US
Mailing Address - Phone:662-269-3870
Mailing Address - Fax:
Practice Address - Street 1:218 S THOMAS ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5330
Practice Address - Country:US
Practice Address - Phone:662-269-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875837261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care