Basic Information
| Provider Information | |||||||||
| NPI: | 1437176294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J W CAMPBELL DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 338 COEBURN AVE SW | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242732606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766790800 | ||||||||
| FaxNumber: | 2766790097 | ||||||||
| Practice Location | |||||||||
| Address1: | 338 COEBURN AVE SW | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242732606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766790800 | ||||||||
| FaxNumber: | 2766790097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2766790800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0102201836 | VA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 0102201836 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010294321 | 05 | VA | MEDICAID |