Healthcare Provider Details

I. General information

NPI: 1962550020
Provider Name (Legal Business Name): PHYSICIAN'S PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 E 10TH ST
JEFFERSONVILLE IN
47130-6016
US

IV. Provider business mailing address

1804 E 10TH ST
JEFFERSONVILLE IN
47130-6016
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-2488
  • Fax: 812-288-6603
Mailing address:
  • Phone: 812-288-2488
  • Fax: 812-288-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001741A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23424
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003535
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01036153A
License Number StateIN

VIII. Authorized Official

Name: DR. JEFFREY A CAMPBELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 812-288-2488