Healthcare Provider Details

I. General information

NPI: 1104017227
Provider Name (Legal Business Name): C. E. CAMPBELL, JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 FULTON ST
BLYTHEVILLE AR
72315-1922
US

IV. Provider business mailing address

609 FULTON ST
BLYTHEVILLE AR
72315-1922
US

V. Phone/Fax

Practice location:
  • Phone: 870-763-0855
  • Fax: 870-763-0858
Mailing address:
  • Phone: 870-763-0855
  • Fax: 870-763-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR1755
License Number StateAR

VIII. Authorized Official

Name: LYNDA WHITE
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 870-763-0855