MEDICARE: MR. JOSEPH EDWARD SHAMP BE BOCO, LPOA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	OPPA0006	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPPA0006	OTHER	AR	ARKANSAS BOARD OF MEDICAL LICENSING FOR O&P

General Provider Information

NPI Number	:	1245598143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH EDWARD SHAMP BE BOCO, LPOA

Provider Business Mailing Address
First Line	:	3500 S 79TH ST STE A
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6250
Country	:	US
Telephone Number	:	479-484-1620
Fax Number	:	479-484-1619

Provider Business Practice Location Address
First Line	:	3500 S 79TH ST STE A
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6250
Country	:	US
Telephone Number	:	479-484-1620
Fax Number	:	479-484-1619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	07/09/2012

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Directions to “ MR. JOSEPH EDWARD SHAMP BE BOCO, LPOA” Practice Location

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