Provider Demographics
NPI:1164460655
Name:VANCAMP, KIPP ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:KIPP
Middle Name:ALLEN
Last Name:VANCAMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:22740 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3553
Mailing Address - Country:US
Mailing Address - Phone:913-745-5300
Mailing Address - Fax:913-745-5530
Practice Address - Street 1:6800 HILLTOP RD STE 103
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3571
Practice Address - Country:US
Practice Address - Phone:913-745-5300
Practice Address - Fax:253-292-2090
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05253112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1002234960HMedicaid
KSKA1066001OtherKS MEDICARE
KSP00477479OtherRR MEDICARE
KS100234960FMedicaid
KSP00440177OtherRAILROAD MEDICARE GROUP DG5299
KS106163OtherBCBS OF KS
KS104991OtherBCBS PROVIDER NUMBER
MO18484065OtherBCBS OF KANSAS CITY
KS106163OtherBCBS OF KS
KSP00477479OtherRR MEDICARE
KS1002234960HMedicaid
KS106163OtherBCBS OF KS