MEDICARE: CAMPUS MEDICAL LLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1184201311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPUS MEDICAL LLC

Provider Business Mailing Address
First Line	:	10850 PROVIDENCE RD # 1005
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2684
Country	:	US
Telephone Number	:	844-888-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	10850 PROVIDENCE RD # 1005
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2684
Country	:	US
Telephone Number	:	844-888-0404
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICKA MARTIN
Credential	:	APRN
Telephone Number	:	844-888-0404

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	03/25/2021

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Directions to “CAMPUS MEDICAL LLC ” Practice Location

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