Healthcare Provider Details

I. General information

NPI: 1639163314
Provider Name (Legal Business Name): SCOTT CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DECATUR ST
SANDUSKY OH
44870-3335
US

IV. Provider business mailing address

2203 EAGLES NEST CIR
SANDUSKY OH
44870-7024
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-7400
  • Fax:
Mailing address:
  • Phone: 419-625-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number35060794C
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0841094
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: