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NPI Code Detail

MEDICARE: LOUIE CAMPBELL PA

MEDICARE: LOUIE CAMPBELL PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant649OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356347629
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUIE CAMPBELL PA
Provider Business Mailing Address
First Line : 5300 N INDEPENDENCE AVE
Second Line : 280
City : OKLAHOMA CITY
State : OK
Zip : 73112-5556
Country : US
Telephone Number : 580-233-9012
Fax Number : 580-249-4269
Provider Business Practice Location Address
First Line : 1805 W GARRIOTT RD
Second Line :
City : ENID
State : OK
Zip : 73703-5526
Country : US
Telephone Number : 580-233-9012
Fax Number : 580-249-4269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 01/25/2016

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Directions to “ LOUIE CAMPBELL PA” Practice Location

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