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NPI Code Detail

MEDICARE: KIMBERLY JORDAN CAMPBELL M.D.

MEDICARE: KIMBERLY JORDAN 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
1207Q00000XFamily Medicine PhysicianM11531ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
6P00767193OTHERMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101-37459OTHERMEDICA
21861669988OTHERMNBCBS
31861669988OTHERGROUP HEALTH
41861669988OTHERIDREGENCE BLUE SHIELD
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861669988
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JORDAN CAMPBELL M.D.
Provider Business Mailing Address
First Line : 611 N IRON BRIDGE WAY
Second Line :
City : SPOKANE
State : WA
Zip : 99202-4932
Country : US
Telephone Number : 509-444-8888
Fax Number :
Provider Business Practice Location Address
First Line : 1203 IDAHO ST
Second Line :
City : LEWISTON
State : ID
Zip : 83501-1940
Country : US
Telephone Number : 509-444-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2008
Last Update Date : 12/02/2024

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