Provider Demographics
NPI:1639887581
Name:COMPASS IMMUNO ONCOLOGY LLC
Entity type:Organization
Organization Name:COMPASS IMMUNO ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE
Authorized Official - Prefix:
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYBILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-424-9888
Mailing Address - Street 1:CORREO VILLA
Mailing Address - Street 2:AA-2 AVE TEGAS PMB 289
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LEGACY MEDICAL CENTER
Practice Address - Street 2:12 CALLE VICTORIA SUITE 22
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00971-4293
Practice Address - Country:US
Practice Address - Phone:787-266-9151
Practice Address - Fax:787-520-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty