1235352915 NPI number — SARAH E. CAMPBELL L.P.C., A.T.R.-B.C.

Table of content: SARAH E. CAMPBELL L.P.C., A.T.R.-B.C. (NPI 1235352915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235352915 NPI number — SARAH E. CAMPBELL L.P.C., A.T.R.-B.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
SARAH
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.C., A.T.R.-B.C.
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:
1235352915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 253
Provider Second Line Business Mailing Address:
WYANDOTTE
Provider Business Mailing Address City Name:
WYANDOTTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48192-0253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-516-4163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 WALNUT ST
Provider Second Line Business Practice Location Address:
WYANDOTTE
Provider Business Practice Location Address City Name:
WYANDOTTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48192-4633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-516-4163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

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: 101YP2500X , with the licence number:  6401004348 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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