NPI Record of CAMPBELL MEDICAL GROUP (CAMPBELL MEDICAL GROUP, MD, PSC) NPI 1003000803

Family Medicine in Glasgow, KY

Complete NPI Record

Field Name Value Definition
NPI1003000803The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameCAMPBELL MEDICAL GROUP, MD, PSCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameCAMPBELL MEDICAL GROUPOther name by which the organization provider is or has been known.
Provider Other Organization Name Type Code5Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address303 PROFESSIONAL PARK DRThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameGLASGOWThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameKYThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code421413487The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number2706293772The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number2706293774The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address303 PROFESSIONAL PARK DRThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameGLASGOWThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameKYThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code421413487The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number2706293772The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2706293774The fax number associated with the location address of the provider being identified.
Provider Enumeration Date9/5/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date12/5/2007The date that a record was last updated or changed.
Authorized Official Last NameGIBSONThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJENNIFERThe first name of the authorized official.
Authorized Official Middle NameDALTONThe middle name of the authorized official.
Authorized Official Title or PositionOFFICE MANAGERThe title or position of the authorized official.
Authorized Official Telephone Number2706293772The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1207RA0000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 134221The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1KYThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 2363L00000X
Provider License Number 24716PThe license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2KYThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2N
Healthcare Provider Taxonomy Code 3207Q00000X
Provider License Number 333935The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3KYThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3Y
Other Provider Identifier 1000000360876Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 101Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1KY
Other Provider Identifier Issuer 1BLUE CROSS BLUE SHIELD
Other Provider Identifier 264095326Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 205Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2KY
Other Provider Identifier 364019003Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 305Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3KY
Other Provider Identifier 4000000333249Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 401Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4KY
Other Provider Identifier Issuer 4BLUE CROSS BLUE SHIELD
Is Organization SubpartN
Authorized Official Name Prefix TextMS.
Authorized Official Credential TextRHIT
Healthcare Provider Taxonomy Group 1193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2193400000X MULTIPLE SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3193400000X MULTIPLE SINGLE SPECIALTY GROUP