1609882968 NPI number — DR. WILLIAM S. CAMPBELL JR. MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609882968 NPI number — DR. WILLIAM S. CAMPBELL JR. MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CAMPBELL

Provider First Name:

WILLIAM

Provider Middle Name:

S.

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

JR.

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1609882968

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/23/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

609 N BAY DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LYNN HAVEN

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

32444-3026

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

503-813-8478

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

609 N BAY DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LYNN HAVEN

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

32444-3026

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

503-813-8478

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/31/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  R1J43 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0204X , with the licence number: ME51689 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: ME51689 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 063896 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 430954380CAP . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 95529 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 036-068623 . This is a "IL BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 143789001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 202664801 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 277988900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 185214 . This is a "MO BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 254725 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
• Identifier: 277988900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".