MEDICARE: CAMPBELL CLINIC PC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1619152642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELL CLINIC PC

Provider Business Mailing Address
First Line	:	1400 S GERMANTOWN RD
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-2205
Country	:	US
Telephone Number	:	901-759-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-0605
Country	:	US
Telephone Number	:	901-759-3100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANIEL SHUMATE
Credential	:
Telephone Number	:	901-759-3100

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	06/09/2025

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