1053520221 NPI number — JANINE S CAMPLIN RN, MSN, APN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053520221 NPI number — JANINE S CAMPLIN RN, MSN, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPLIN
Provider First Name:
JANINE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053520221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CENTRA MEDICAL GROUP - THE SUMMIT HEALTH AND REHAB
Provider Second Line Business Mailing Address:
1400 ENTERPRISE DR
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-582-1500
Provider Business Mailing Address Fax Number:
630-232-3985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRA MEDICAL GROUP - THE SUMMIT
Provider Second Line Business Practice Location Address:
1400 ENTERPRISE DR
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-927-8213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007

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: 363L00000X , with the licence number:  209002162 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 0024178497 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: $$$$$$$$$ , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01108937 . This is a "MEDICARE RAILROAD (INDIVIDUAL)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 206147 . This is a "MEDICARE PTAN (GROUP)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CA4748 . This is a "MEDICARE RAILROAD (GROUP)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: T01566 . This is a "MEDICARE PTAN (INDIVIDUAL)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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