Provider Demographics
NPI:1447431598
Name:COMPTON HEALTHCARE INC
Entity type:Organization
Organization Name:COMPTON HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:228-896-6640
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0674
Mailing Address - Country:US
Mailing Address - Phone:228-896-6640
Mailing Address - Fax:228-896-6641
Practice Address - Street 1:412 SECURITY SQ
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1952
Practice Address - Country:US
Practice Address - Phone:228-896-6640
Practice Address - Fax:228-896-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121014Medicaid
MSG25349Medicare UPIN
MS00121014Medicaid