Provider Demographics
NPI:1215914809
Name:COMPTON, RICKY JACK (MD)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:JACK
Last Name:COMPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:RADIOLOGY INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:5221 US ROUTE 60 E
Practice Address - Street 2:RADIOLOGY INC
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2022
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV197682085R0202X
KY361622085R0202X
OH35-081148-C2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7027126OtherAETNA
WV7200297000Medicaid
KYP00766033OtherRR MEDICARE (KY)
WV300114636OtherRR MEDICARE (WV)
KY6402538000Medicaid
OH000000196595OtherUNISON
KY50007265OtherPASSPORT
001718781OtherMTN STATE BCBS
OH2140123Medicaid
WV55049337600OtherWORKMANS COMP
OH000000196595OtherUNISON
H06623Medicare UPIN
WV7200297000Medicaid
WV4028181Medicare PIN