MEDICARE: D SCOTT CAMPANINI M.D.

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	2085R0202X	Diagnostic Radiology Physician	J4738	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1740271451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D SCOTT CAMPANINI M.D.

Provider Business Mailing Address
First Line	:	4102 RICHMOND MDWS
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-0067
Country	:	US
Telephone Number	:	903-223-1014
Fax Number	:	903-223-1028

Provider Business Practice Location Address
First Line	:	4102 RICHMOND MDWS
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-0067
Country	:	US
Telephone Number	:	903-223-1014
Fax Number	:	903-223-1028

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/17/2015

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