Provider Demographics
NPI:1447735691
Name:COMPASSION MEDICAL SUPPLY
Entity type:Organization
Organization Name:COMPASSION MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-622-9777
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:OVERGAARD
Mailing Address - State:AZ
Mailing Address - Zip Code:85933-0636
Mailing Address - Country:US
Mailing Address - Phone:480-622-9777
Mailing Address - Fax:
Practice Address - Street 1:2402 KIMBALL ST
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:AZ
Practice Address - Zip Code:85928
Practice Address - Country:US
Practice Address - Phone:928-535-3366
Practice Address - Fax:928-492-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ978494Medicaid