MEDICARE: SUSAN L CAMPBELL CNM

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
1	367A00000X	Advanced Practice Midwife	APRN.CNM.10196	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00665594	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063413029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L CAMPBELL CNM

Provider Business Mailing Address
First Line	:	90 JACKSON PIKE
Second Line	:
City	:	GALLIPOLIS
State	:	OH
Zip	:	45631-1560
Country	:	US
Telephone Number	:	740-589-3100
Fax Number	:	740-589-3123

Provider Business Practice Location Address
First Line	:	2131 EAST STATE ST.
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701
Country	:	US
Telephone Number	:	740-589-3100
Fax Number	:	740-589-3123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	11/09/2017

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Directions to “ SUSAN L CAMPBELL CNM” Practice Location

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