Provider Demographics
NPI:1982973525
Name:CLUMPNER, MICHAEL DAVID (PHD(C), MBA, NREMT-P)
Entity type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:DAVID
Last Name:CLUMPNER
Suffix:
Gender:M
Credentials:PHD(C), MBA, NREMT-P
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 620183
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0103
Mailing Address - Country:US
Mailing Address - Phone:704-506-3640
Mailing Address - Fax:
Practice Address - Street 1:101 E. WOOD STREET
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:704-506-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP039485146L00000X
SCSC014421146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic