MEDICARE: CAMPBELL AND CREW 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1851124937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELL AND CREW LLC

Provider Business Mailing Address
First Line	:	11055 E WAGON TRAIL RD
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-9680
Country	:	US
Telephone Number	:	307-258-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	11055 E WAGON TRAIL RD
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-9680
Country	:	US
Telephone Number	:	307-258-0511
Fax Number	:

Authorized Official
Title or Position	:	CASE MANAGER
Name	:	MELISSA CAMPBELL
Credential	:
Telephone Number	:	307-258-0511

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/26/2024

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