MEDICARE: JAMES CAMPIONE

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	106S00000X	Behavior Technician		AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00003173	OTHER	AK	TRICARE

General Provider Information

NPI Number	:	1255846846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES CAMPIONE

Provider Business Mailing Address
First Line	:	16941 N. EAGLE RIVER LOOP RD EAGLE RIVER
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577
Country	:	US
Telephone Number	:	907-726-5330
Fax Number	:

Provider Business Practice Location Address
First Line	:	16941 N EAGLE RIVER LOOP RD
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7824
Country	:	US
Telephone Number	:	907-382-7041
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	04/30/2018

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