Healthcare Provider Details

I. General information

NPI: 1902998917
Provider Name (Legal Business Name): NICHOLAS CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N OAK ST
TOWNSEND MT
59644-2306
US

IV. Provider business mailing address

PO BOX 1027 100 N. OAK
TOWNSEND MT
59644-1027
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-5204
  • Fax: 406-266-4428
Mailing address:
  • Phone: 406-266-5204
  • Fax: 406-266-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4938
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: