Provider Demographics
NPI:1821334996
Name:ROCKINHGAM MEDICAL CLINIC
Entity Type:Organization
Organization Name:ROCKINHGAM MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMARGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-910-2320
Mailing Address - Street 1:101 E MATTHEWS ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5373
Mailing Address - Country:US
Mailing Address - Phone:980-339-7442
Mailing Address - Fax:980-339-5925
Practice Address - Street 1:3535 RANDOLPH RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1086
Practice Address - Country:US
Practice Address - Phone:704-906-1676
Practice Address - Fax:704-910-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163710OtherINDIVIDUAL MEDICARE
NC5918242Medicaid
NCA305OtherGROUP MEDICARE
P0100359OtherRR MEDICARE PTAN