Basic Information
| Provider Information | |||||||||
| NPI: | 1467783696 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMPUS CLINICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 10TH AVE | ||||||||
| Address2: | CASSIDY HALL | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806395545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703512412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 10TH AVE, CAMPUS BOX 37 | ||||||||
| Address2: | CASSIDY HALL | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703512412 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 01/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | GINN | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9703512412 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5112 | CO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 363A00000X | 2468 | CO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | 184924 | CO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | 32068 | CO | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.