Healthcare Provider Details

I. General information

NPI: 1518577568
Provider Name (Legal Business Name): JOHN N CAMPBELL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E KENT RD
GREENVILLE MI
48838-9791
US

IV. Provider business mailing address

1676 VIEWPOND DR SE STE 100A
KENTWOOD MI
49508-4994
US

V. Phone/Fax

Practice location:
  • Phone: 616-225-0202
  • Fax: 616-225-0207
Mailing address:
  • Phone: 616-455-9450
  • Fax: 616-455-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN N CAMPBELL
Title or Position: OWNER/DOCTOR
Credential: MD
Phone: 616-455-9450