Healthcare Provider Details

I. General information

NPI: 1477783090
Provider Name (Legal Business Name): JOHN CAMPO CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 HIGDON FERRY RD SUITE A
HOT SPRINGS AR
71913-6913
US

IV. Provider business mailing address

168 TULL TRL
HOT SPRINGS AR
71913-8341
US

V. Phone/Fax

Practice location:
  • Phone: 501-525-2770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number0575
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: