1861482887 NPI number — ERIC J CAMPBELL PA-C

Table of content: ERIC J CAMPBELL PA-C (NPI 1861482887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861482887 NPI number — ERIC J CAMPBELL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
ERIC
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1861482887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2451 E BASELINE RD STE 425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85234-0049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-260-8605
Provider Business Mailing Address Fax Number:
405-369-9310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17937 N PENNSYLVANIA AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73012-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-260-8605
Provider Business Practice Location Address Fax Number:
405-369-9310
Provider Enumeration Date:
10/21/2005

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100138410B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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