Provider Demographics
NPI:1770581571
Name:SAMPOGNARO, JAMES K (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:SAMPOGNARO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 FOREST HOLLOW PARK
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7825
Mailing Address - Country:US
Mailing Address - Phone:214-327-2271
Mailing Address - Fax:214-327-2271
Practice Address - Street 1:4916 OVERTON PLZ
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4415
Practice Address - Country:US
Practice Address - Phone:888-804-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553146367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126074706Medicaid
TXR69987Medicare UPIN
TX8B3562Medicare ID - Type Unspecified00C17N
TX8J5499Medicare PIN