Provider Demographics
NPI:1720196710
Name:OCAMPO MEDICAL CENTERS, LLC.
Entity Type:Organization
Organization Name:OCAMPO MEDICAL CENTERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OCAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-922-6911
Mailing Address - Street 1:3100 - 45 TH ST.
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3289
Mailing Address - Country:US
Mailing Address - Phone:219-922-6911
Mailing Address - Fax:219-922-6968
Practice Address - Street 1:3100 - 45 TH ST.
Practice Address - Street 2:SUITE # 3
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3289
Practice Address - Country:US
Practice Address - Phone:219-922-6911
Practice Address - Fax:219-922-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INO1058122A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200454910AMedicaid
227130AMedicare ID - Type Unspecified
INH43548Medicare UPIN