Healthcare Provider Details

I. General information

NPI: 1700899416
Provider Name (Legal Business Name): KENNETH CAMPBELL JR. CSA,SA-C,LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506-71ST
LUBBOCK TX
79424
US

IV. Provider business mailing address

5506 71ST ST
LUBBOCK TX
79424-1802
US

V. Phone/Fax

Practice location:
  • Phone: 806-798-3380
  • Fax: 806-792-9180
Mailing address:
  • Phone: 806-798-3380
  • Fax: 806-792-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: