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: | |||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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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 |