MEDICARE: JEREMY EARL HAMPTON DO

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	207Q00000X	Family Medicine Physician	2877	WV
2	207Q00000X	Family Medicine Physician	02004882A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01723963	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588004923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY EARL HAMPTON DO

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12130 E WASHINGTON ST
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2955
Country	:	US
Telephone Number	:	317-355-7752
Fax Number	:	317-355-7750

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

Provider Enumeration Date	:	06/30/2013
Last Update Date	:	11/27/2023

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