1659393684 NPI number — DR. LOWELL MASON CAMPBELL III PSYD, LP

Table of content: DR. LOWELL MASON CAMPBELL III PSYD, LP (NPI 1659393684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659393684 NPI number — DR. LOWELL MASON CAMPBELL III PSYD, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
LOWELL
Provider Middle Name:
MASON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PSYD, LP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
LOWELL
Provider Other Middle Name:
MASON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
PSYD LP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659393684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
287 MARSCHALL RD STE 203
Provider Second Line Business Mailing Address:
PO BOX 336
Provider Business Mailing Address City Name:
SHAKOPEE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55379-1678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-445-1397
Provider Business Mailing Address Fax Number:
952-445-1398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
287 MARSCHALL RD STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAKOPEE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55379-1678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-445-1397
Provider Business Practice Location Address Fax Number:
952-445-1398
Provider Enumeration Date:
07/25/2006

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: 103T00000X , with the licence number:  LP2631 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01010981 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 61-20043 . This is a "MEDICA ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1346259041 . This is a "IND NPI#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 51217CA . This is a "BCBS GROUP ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 51053CA . This is a "BCBS ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP19455 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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