1801877071 NPI number — TAMMY CAMP M.D.

Table of content: TAMMY CAMP M.D. (NPI 1801877071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801877071 NPI number — TAMMY CAMP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMP
Provider First Name:
TAMMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1801877071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5865
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79408-5865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-743-2898
Provider Business Mailing Address Fax Number:
806-743-2787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3502 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79415-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-1188
Provider Business Practice Location Address Fax Number:
806-743-1187
Provider Enumeration Date:
11/07/2005

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: 208000000X , with the licence number:  J8480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80854Z . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109780100 . This is a "FIRSTCARE COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 59099 . This is a "PRESBYTERIAN COMMERCIAL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 105335702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109780101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59099 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105335701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: A024 . This is a "TRIWEST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: R8595 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100166630A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86Z587 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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