Active NPI
Mumtaz Khan, PA
- Physician Assistant
- Fort Campbell, KY
National Provider Identifier
1093795726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1919
- Practice address
- 650 Joel Dr
Blanchfield Hospital
Fort Campbell, KY 42223-5318 - Phone
- (270) 798-8388
- NPI assigned
- Jan 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1919 | WI | Primary |
Addresses
Primary practice location
650 Joel Dr
Blanchfield Hospital
Fort Campbell, KY 42223-5318
Mailing address
650 Joel Dr
Blanchfield Hospital
Fort Campbell, KY 42223-5318
Phone (270) 798-8388
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42873300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1919 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414368000000",
"number": "1093795726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"address_2": "BLANCHFIELD HOSPITAL",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "270-798-8388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"address_2": "BLANCHFIELD HOSPITAL",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "270-798-8388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "MUMTAZ",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2014-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1919",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42873300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.