1184637795 NPI number — SARAH C CAMPBELL MD

Table of content: SARAH C CAMPBELL MD (NPI 1184637795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184637795 NPI number — SARAH C CAMPBELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
SARAH
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1184637795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1506 S. ONEIDA STREET
Provider Second Line Business Mailing Address:
PEDIATRICS
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54915-1569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-730-4950
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1506 S. ONEIDA STREET
Provider Second Line Business Practice Location Address:
PEDIATRICS
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54915-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-730-4950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2006

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: 208000000X , with the licence number:  45366 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 4301083413 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 35388600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0829560001 . This is a "MEDICARE DME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: SC083413 . This is a "BLUE CROSS STATE ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0C16002 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104654657 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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