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General NPI Number Information
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NPI Number | 1750822771
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Entity Type | Individual
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Provider Name | BILLY RAY CAMPBELL III CPED, CFO
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Gender | Male
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 315 E BROADWAY STE 1400
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City | LOUISVILLE
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State | KY
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Zip | 40202-3700
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Country | US
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Telephone | 502-629-8640
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Fax | 502-629-5527
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Provider Business Mailing Address
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Address Line | 3401 IMPERATOR LN UNIT 102
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City | LOUISVILLE
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State | KY
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Zip | 40245-7707
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Country | US
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Telephone | 502-593-6119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number | CPED3595
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number | CFO04010
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License Number State | KY
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