MEDICARE: DR. SAMUEL J. CAMPBELL M.D.

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	2086S0129X	Vascular Surgery Physician	G3209	TX
2	208600000X	Surgery Physician	G3209	TX

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

General Provider Information

NPI Number	:	1528033446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL J. CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5865
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79408-5865
Country	:	US
Telephone Number	:	806-743-2898
Fax Number	:	806-743-2787

Provider Business Practice Location Address
First Line	:	3601 4TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79430-8312
Country	:	US
Telephone Number	:	806-743-2373
Fax Number	:	806-743-4354

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	02/17/2014

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