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General NPI Number Information
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NPI Number | 1801069158
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Entity Type | Organization
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Legal Business Name | BLACK HILLS UROLOGY GROUP, P.C.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 294 W STATE ROUTE 89A SUITE 208
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3754
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Country | US
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Telephone | 928-649-7970
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Fax | 928-649-7971
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Provider Business Mailing Address
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Address Line | 294 W STATE ROUTE 89A SUITE 208
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3754
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Country | US
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Telephone | 928-649-7970
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Fax | 928-649-7971
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Authorized Official
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Title or Position | CO.OWNER/PRESIDENT
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Name | DR. MICHAEL A CAMPENNI
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Credential | D.O.
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Telephone | 928-649-7970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 36999
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4639
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License Number State | AZ
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