1548596810 NPI number — ERIN LINDSEY CAMPBELL PA-C LLC

Table of content: ERIN LINDSEY CAMPBELL PA-C LLC (NPI 1548596810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548596810 NPI number — ERIN LINDSEY CAMPBELL PA-C LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
ERIN
Provider Middle Name:
LINDSEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C LLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENJAMIN
Provider Other First Name:
ERIN
Provider Other Middle Name:
LINDSEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548596810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWCASTLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95658-0506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-360-6080
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9192 LOS PUENTES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWCASTLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95658-9706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-360-6080
Provider Business Practice Location Address Fax Number:
208-506-7953
Provider Enumeration Date:
10/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  54013 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54013 . This is a "PHYSICIAN ASSISTANT SURGICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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