Basic Information
Provider Information | |||||||||
NPI: | 1295723070 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KEMP | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 200 HAWKINS DR | ||||||||
Address2: |   | ||||||||
City: | IOWA CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 522421009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3193849611 | ||||||||
FaxNumber: | 3193849613 | ||||||||
Practice Location | |||||||||
Address1: | 200 HAWKINS DR | ||||||||
Address2: |   | ||||||||
City: | IOWA CITY | ||||||||
State: | IA | ||||||||
PostalCode: | 522421009 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3193849611 | ||||||||
FaxNumber: | 3193849613 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2005 | ||||||||
LastUpdateDate: | 12/19/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZI0100X | 23060 | IA | Y |   | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | 207ZP0102X | 23060 | IA | N |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0105X | 23060 | IA | N |   | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
ID | Type | State | Issuer | Description | 1224410 | 05 | IA |   | MEDICAID | 22441 | 01 | IA | WELLMARK BCBS | OTHER | 33939 | 01 | IA | WELLMARK BCBS | OTHER | 0224410 | 05 | IA |   | MEDICAID |