Basic Information
| Provider Information | |||||||||
| NPI: | 1518063585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1804 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471306016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122882488 | ||||||||
| FaxNumber: | 8122886603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1804 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471306016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122882488 | ||||||||
| FaxNumber: | 8122886603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01036153 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 23424 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | 23424 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207LA0401X | 23424 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207LA0401X | 01036153A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080067815 | 01 | IN | PALMETTO | OTHER | 100464320 | 05 | IN | MEDICAID | 1195507 | 01 | IN | CHA HEALTH | OTHER | 000000050807 | 01 | IN | ANTHEM | OTHER | 004272 | 01 | IN | SIHO | OTHER | 1018897 | 01 | IN | CHAMPUS | OTHER |