1811259674 NPI number — DR. SAVANNAH CATHERINE CAMPBELL LCP

Table of content: DR. SAVANNAH CATHERINE CAMPBELL LCP (NPI 1811259674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811259674 NPI number — DR. SAVANNAH CATHERINE CAMPBELL LCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
SAVANNAH
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCP
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:
1811259674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 CRANES ROOST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42701-3650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-765-2065
Provider Business Mailing Address Fax Number:
270-234-8572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2939 HIGHWAY 441
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLESBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40965-8788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-226-4537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2012

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: 103T00000X , with the licence number:  KY-274664 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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