MEDICARE: COURTNEY MARIE CAMPOS PA-C

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	363A00000X	Physician Assistant	0110007576	VA
2	363A00000X	Physician Assistant	50.004275RX	OH

General Provider Information

NPI Number	:	1154717866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MARIE CAMPOS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 E STATE ST STE 670
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4360
Country	:	US
Telephone Number	:	614-566-7432
Fax Number	:

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

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	09/18/2023

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Directions to “ COURTNEY MARIE CAMPOS PA-C” Practice Location

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