Basic Information
Provider Information | |||||||||
NPI: | 1205924818 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VANCAMPEN | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VANCAMPEN | ||||||||
OtherFirstName: | ROBERT | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNA | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 259 CLAUDE COOK RD | ||||||||
Address2: |   | ||||||||
City: | SYLVA | ||||||||
State: | NC | ||||||||
PostalCode: | 287798571 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8285867000 | ||||||||
FaxNumber: | 8285867449 | ||||||||
Practice Location | |||||||||
Address1: | 68 HOSPITAL RD | ||||||||
Address2: |   | ||||||||
City: | SYLVA | ||||||||
State: | NC | ||||||||
PostalCode: | 287792722 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8285867000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/10/2006 | ||||||||
LastUpdateDate: | 01/09/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 36617 | NC | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 8000180 | 05 | NC |   | MEDICAID | 8000315 | 05 | NC |   | MEDICAID | 36617 | 01 | NC | STATE LICENSE | OTHER | 430034954 | 01 | NC | HRH RR | OTHER | R42915 | 01 | NC | CIGNA PRO. | OTHER | 430079570 | 01 | NC | SCH RR | OTHER |