=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336218239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDDIE CAMPBELL RRT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1642 SOUTH PARKER RD STE 201
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80231-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-368-4018
-----------------------------------------------------
Fax | 303-368-8973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1642 SOUTH PARKER RD STE 201
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80231-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-368-4018
-----------------------------------------------------
Fax | 303-368-8973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 1455
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------