Healthcare Provider Details

I. General information

NPI: 1518918739
Provider Name (Legal Business Name): CLINIC FOR COLON & RECTAL SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MANNING DR SW SUITE D101
HUNTSVILLE AL
35801-4315
US

IV. Provider business mailing address

115 MANNING DR SW SUITE D101
HUNTSVILLE AL
35801-4315
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-6070
  • Fax: 256-533-4839
Mailing address:
  • Phone: 256-533-6070
  • Fax: 256-533-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT H CAMPBELL JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 256-533-6070