Basic Information
| Provider Information | |||||||||
| NPI: | 1669716205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMPBELL UNIVERSITY INC | ||||||||
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| OtherOrganizationName: | CAMPBELL UNIVERSITY ATHLETICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 EAKES DRIVE | ||||||||
| Address2: | MCLEOD ATHLETIC TRAINING FACILIATY | ||||||||
| City: | LILLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108145455 | ||||||||
| FaxNumber: | 9108931283 | ||||||||
| Practice Location | |||||||||
| Address1: | 5050 SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752443995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723674820 | ||||||||
| FaxNumber: | 9723673451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FOR BUSINESS AND TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 9108931240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Student Health |
No ID Information.