# CAMPBELL MEDICAL GROUP, MD, PSC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CAMPBELL MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003000803
- **Authorized official:** MS. JENNIFER DALTON GIBSON RHIT (OFFICE MANAGER)
- **Authorized official phone:** (270) 629-3772

## Contact information

- **Practice address:** 303 PROFESSIONAL PARK DR, GLASGOW, KY 42141-3487
- **Practice address phone:** (270) 629-3772
- **Practice address fax:** (270) 629-3774
- **Mailing address:** 303 PROFESSIONAL PARK DR, GLASGOW, KY 42141-3487
- **Mailing address phone:** (270) 629-3772
- **Mailing address fax:** (270) 629-3774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 33935 | KY | Yes |
| 207RA0000X | Adolescent Medicine (Internal Medicine) Physician | 34221 | KY | — |
| 363L00000X | Nurse Practitioner | 4716P | KY | — |

## Other

- **Enumeration date:** 09/05/2007
- **Last updated:** 12/05/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000333249 | BLUE CROSS BLUE SHIELD | KY |
| 01 | — | 000000360876 | BLUE CROSS BLUE SHIELD | KY |
| 05 | — | 64019003 | — | KY |
| 05 | — | 64095326 | — | KY |