Provider Demographics
NPI:1801069158
Name:BLACK HILLS UROLOGY GROUP, P.C.
Entity type:Organization
Organization Name:BLACK HILLS UROLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO.OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPENNI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-649-7970
Mailing Address - Street 1:294 W STATE ROUTE 89A
Mailing Address - Street 2:SUITE 208
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3754
Mailing Address - Country:US
Mailing Address - Phone:928-649-7970
Mailing Address - Fax:928-649-7971
Practice Address - Street 1:294 W STATE ROUTE 89A
Practice Address - Street 2:SUITE 208
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3754
Practice Address - Country:US
Practice Address - Phone:928-649-7970
Practice Address - Fax:928-649-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36999208800000X
AZ4639208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ328233Medicaid
AZ4639OtherFOR DR. MICHAEL CAMPENNI
AZ1801069158OtherGROUP NPI FOR BLACK HILLS UROLOGY
AZ36999OtherFOR DR. STEVEN KURZWEIL
AZ324852Medicaid
AZ328233Medicaid
AZZ122007Medicare PIN