1194774513 NPI number — DR. SYLVIA D CAMPBELL M.D.

Table of content: DR. SYLVIA D CAMPBELL M.D. (NPI 1194774513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194774513 NPI number — DR. SYLVIA D CAMPBELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
SYLVIA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1194774513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 S MATANZAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33609-3010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-875-2655
Provider Business Mailing Address Fax Number:
813-872-1838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 S MATANZAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-875-2655
Provider Business Practice Location Address Fax Number:
813-872-1838
Provider Enumeration Date:
05/10/2006

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: 174400000X , with the licence number:  ME32624 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 067048100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020001834 . This is a "RR MCR ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33660 . This is a "GHI ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30483 . This is a "BCBS ID #" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 592316341 . This is a "FEDERAL TAX ID" identifier . This identifiers is of the category "OTHER".




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