1336293547 NPI number — DR. JAMES R CAMPBELL JR. DDS

Table of content: DR. JAMES R CAMPBELL JR. DDS (NPI 1336293547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336293547 NPI number — DR. JAMES R CAMPBELL JR. DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
JAMES
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DDS
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:
1336293547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKER
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-778-5150
Provider Business Mailing Address Fax Number:
406-778-5151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S 4TH ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-778-5150
Provider Business Practice Location Address Fax Number:
406-778-5151
Provider Enumeration Date:
01/23/2007

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: 1223G0001X , with the licence number:  1906 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111197 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5511536 . This is a "BLUECHIP" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 41167 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5511531 . This is a "BLUECHIP" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 942710 . This is a "BLUE CROSS BLUE SHIELD ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 0111214 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19064 . This is a "BLUE CROSS BLUE SHIELD MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 40784 . This is a "BLUE CROSS BLUE SHIELD MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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