1215953310 NPI number — ROBERT S CAMPBELL PA

Table of content: ROBERT S CAMPBELL PA (NPI 1215953310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215953310 NPI number — ROBERT S CAMPBELL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
ROBERT
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1215953310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 S COLORADO BLVD
Provider Second Line Business Mailing Address:
SUITE 220A
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80246-1912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-584-8231
Provider Business Mailing Address Fax Number:
866-210-0907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12207 PECOS ST
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80031-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-650-0445
Provider Business Practice Location Address Fax Number:
303-429-5088
Provider Enumeration Date:
07/14/2006

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: 363AM0700X , with the licence number:  46 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C811604 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 011500 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 348308 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 98579274 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com