Organization
CAMPBELL MEDICAL GROUP, MD, PSC
Active
Other names
CAMPBELL MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER DALTON GIBSON RHIT (OFFICE MANAGER)
(270) 629-3772
Entity
Organization
Contact information
Practice address
303 PROFESSIONAL PARK DR, GLASGOW, KY 42141-3487
(270) 629-3772
(270) 629-3774
Mailing address
303 PROFESSIONAL PARK DR, GLASGOW, KY 42141-3487
(270) 629-3772
(270) 629-3774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33935
KY
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
34221
KY
363L00000X
Nurse Practitioner
4716P
KY
Other
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
Enumeration date
09/05/2007
Last updated
12/05/2007
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