1336111772 NPI number — JOHN R KAMPS MD

Table of content: JOHN R KAMPS MD (NPI 1336111772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336111772 NPI number — JOHN R KAMPS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMPS
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336111772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST MICHAELS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86511-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-810-3814
Provider Business Mailing Address Fax Number:
928-810-3801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359-A W. HIGHWAY 264
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. MICHAELS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86511-0370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-810-3814
Provider Business Practice Location Address Fax Number:
928-810-3801
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  65-38 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208D00000X , with the licence number: 1721 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14563 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1456 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 239914 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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