Basic Information
| Provider Information | |||||||||
| NPI: | 1629128640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WESLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 388 COEBURN AVE SW | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242731823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766790800 | ||||||||
| FaxNumber: | 2766790097 | ||||||||
| Practice Location | |||||||||
| Address1: | 388 COEBURN AVE SW | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242731823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766790800 | ||||||||
| FaxNumber: | 2766790097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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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 | 208000000X | 0102201836 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 0102201836 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00742107 | 01 | VA | RR MEDICARE | OTHER | 7100151660 | 01 | KY | KY MEDICAID | OTHER | 010294321 | 05 | VA | MEDICAID | 1629128640 | 05 | VA | MEDICAID |