1831402692 NPI number — JEFFREY L CAMPBELL MHPP

Table of content: (NPI 1205394137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831402692 NPI number — JEFFREY L CAMPBELL MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
JEFFREY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHPP
Provider Gender Code:
M

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:
1831402692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72231-5968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-221-1843
Provider Business Mailing Address Fax Number:
501-221-2376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 WEST 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONOKE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72086-0438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-676-3151
Provider Business Practice Location Address Fax Number:
501-676-3152
Provider Enumeration Date:
07/22/2010

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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