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General NPI Number Information
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NPI Number | 1104017227
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Entity Type | Organization
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Legal Business Name | C. E. CAMPBELL, JR MD PA
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 609 FULTON ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1922
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Country | US
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Telephone | 870-763-0855
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Fax | 870-763-0858
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Provider Business Mailing Address
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Address Line | 609 FULTON ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1922
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Country | US
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Telephone | 870-763-0855
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Fax | 870-763-0858
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Authorized Official
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Title or Position | BILLING ADMINISTRATOR
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Name | LYNDA WHITE
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Credential |
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Telephone | 870-763-0855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R1755
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License Number State | AR
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