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NPI Code Detail

MEDICARE: TROY MATTHEW CAMPBELL

MEDICARE:   TROY MATTHEW CAMPBELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251C00000XDevelopmentally Disabled Services Day Training Agency
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1053092031
Entity Type Code : Individual
Provider Name (Legal Business Name) : TROY MATTHEW CAMPBELL
Provider Business Mailing Address
First Line : 11055 E WAGON TRAIL RD
Second Line :
City : EVANSVILLE
State : WY
Zip : 82636-9680
Country : US
Telephone Number : 307-258-7917
Fax Number :
Provider Business Practice Location Address
First Line : 11055 E WAGON TRAIL RD
Second Line :
City : EVANSVILLE
State : WY
Zip : 82636-9680
Country : US
Telephone Number : 307-258-7917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2023
Last Update Date : 10/24/2023

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Directions to “ TROY MATTHEW CAMPBELL ” Practice Location

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