Organization
C. E. CAMPBELL, JR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA WHITE (BILLING ADMINISTRATOR)
(870) 763-0855
Entity
Organization
Contact information
Practice address
609 FULTON ST, BLYTHEVILLE, AR 72315-1922
(870) 763-0855
(870) 763-0858
Mailing address
609 FULTON ST, BLYTHEVILLE, AR 72315-1922
(870) 763-0855
(870) 763-0858
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R1755
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103491002
MEDICAID (GROUP)
AR
05
—
103491002
—
AR
01
—
1104017227
GROUP NPI
AR
01
—
1114934353
INDIVIDUAL NPI
AR
05
—
501821003
—
MO
Enumeration date
08/05/2007
Last updated
03/01/2011
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