Provider Demographics
NPI:1922066638
Name:JAIME E. CAMPOS, M.D., P.A.
Entity Type:Organization
Organization Name:JAIME E. CAMPOS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PASION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-556-1544
Mailing Address - Street 1:7100 W 20TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1812
Mailing Address - Country:US
Mailing Address - Phone:305-556-1544
Mailing Address - Fax:305-556-2025
Practice Address - Street 1:7100 W 20TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1812
Practice Address - Country:US
Practice Address - Phone:305-556-1544
Practice Address - Fax:305-556-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027911305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039126300Medicaid
FLD82632Medicare UPIN
FLHO785AMedicare PIN