MEDICARE: MR. NATHANIEL STERLING HAMPSON CPO/LPO

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	POR126	FL
2	224P00000X	Prosthetist	POR126	FL

General Provider Information

NPI Number	:	1770984106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHANIEL STERLING HAMPSON CPO/LPO

Provider Business Mailing Address
First Line	:	2425 PELICAN BAY CT
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7053
Country	:	US
Telephone Number	:	850-774-6985
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 PELICAN BAY CT
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7053
Country	:	US
Telephone Number	:	850-774-6985
Fax Number	:

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

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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