Provider Demographics
NPI:1346213675
Name:CARLOS CAMPOS MD PA
Entity Type:Organization
Organization Name:CARLOS CAMPOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:830-629-8161
Mailing Address - Street 1:189 E AUSTIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4104
Mailing Address - Country:US
Mailing Address - Phone:830-629-8161
Mailing Address - Fax:830-620-4908
Practice Address - Street 1:189 E AUSTIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4104
Practice Address - Country:US
Practice Address - Phone:830-629-8161
Practice Address - Fax:830-620-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9273261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002917-01Medicaid
TX1002917-01Medicaid
C14134Medicare UPIN