Provider Demographics
NPI:1114493715
Name:EC PHYSICIAN ASSISTANT PC
Entity Type:Organization
Organization Name:EC PHYSICIAN ASSISTANT PC
Other - Org Name:ERIN CAMPBELL, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:520-360-6080
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658-0506
Mailing Address - Country:US
Mailing Address - Phone:520-360-6080
Mailing Address - Fax:208-506-7953
Practice Address - Street 1:9192 LOS PUENTES RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:CA
Practice Address - Zip Code:95658-9706
Practice Address - Country:US
Practice Address - Phone:520-360-6080
Practice Address - Fax:208-506-7953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EC PHYSICIAN ASSISTANT PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-22
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54013OtherPA LICENSE