Healthcare Provider Details

I. General information

NPI: 1063125912
Provider Name (Legal Business Name): MR. BRENT CAMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 WOODACRE DR
CINCINNATI OH
45231-2881
US

IV. Provider business mailing address

2251 WOODACRE DR
CINCINNATI OH
45231-2881
US

V. Phone/Fax

Practice location:
  • Phone: 513-544-7775
  • Fax:
Mailing address:
  • Phone: 513-544-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: