MEDICARE: MARC W CAMPBELL MD

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	207R00000X	Internal Medicine Physician	01036961A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	250470	OTHER	IN	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000537927	OTHER	IN	ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669435475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC W CAMPBELL MD

Provider Business Mailing Address
First Line	:	PO BOX 3276
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47731-3276
Country	:	US
Telephone Number	:	812-473-0181
Fax Number	:	812-473-5822

Provider Business Practice Location Address
First Line	:	1415 TIMBER CREEK DR
Second Line	:
City	:	JASPER
State	:	IN
Zip	:	47546-1413
Country	:	US
Telephone Number	:	812-630-9794
Fax Number	:	812-996-0653

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	08/30/2022

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Directions to “ MARC W CAMPBELL MD” Practice Location

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