Provider Demographics
NPI:1316920887
Name:JAMPALA, VIJAY (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:JAMPALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:2407 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549
Practice Address - Country:US
Practice Address - Phone:254-628-0246
Practice Address - Fax:254-200-4090
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH49702084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097895901Medicaid
TXP00080993OtherMEDICARE RAILROAD
TX097895901OtherSUPERIOR HEALTH CHIPS
TX742533636OtherHUMANA/MILITARY-TRICARE
TX90017OtherSCOTT & WHITE HEALTH
TX00D65LOtherBLUE CROSS BLUE SHIELD
TX097895901OtherSUPERIOR HEALTH CHIPS
TX742533636OtherHUMANA/MILITARY-TRICARE