1821426537 NPI number — JOHN C CHAMPION MD

Table of content: MRS. AMY JO DUDLEY ARNP (NPI 1851604813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821426537 NPI number — JOHN C CHAMPION MD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1821426537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92659-6015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-640-4014
Provider Business Mailing Address Fax Number:
949-640-4010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 SUPERIOR AVE
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-640-4014
Provider Business Practice Location Address Fax Number:
949-640-4010
Provider Enumeration Date:
10/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHAMPION
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-640-4014

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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