=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558546853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. TERRY W. CAMPBELL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2008
-----------------------------------------------------
Last Update Date | 01/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3528 BROADWAY ST
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77581-4307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-997-7471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3528 BROADWAY ST
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77581-4307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-997-7471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0095609
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------