MEDICARE: JIMMY LAMPKIN JR.

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1477902906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY LAMPKIN JR.

Provider Business Mailing Address
First Line	:	6275 BOULDER HWY
Second Line	:	APT 2027
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7462
Country	:	US
Telephone Number	:	702-237-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	6275 BOULDER HWY
Second Line	:	APT 2027
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7462
Country	:	US
Telephone Number	:	702-237-0070
Fax Number	:

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	06/06/2016

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