Provider Demographics
NPI:1821426537
Name:JOHN C CHAMPION MD
Entity Type:Organization
Organization Name:JOHN C CHAMPION MD
Other - Org Name:CHAMPION CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-640-4014
Mailing Address - Street 1:PO BOX 16015
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-6015
Mailing Address - Country:US
Mailing Address - Phone:949-640-4014
Mailing Address - Fax:949-640-4010
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-640-4014
Practice Address - Fax:949-640-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABY398AMedicare PIN