Provider Demographics
NPI:1235858143
Name:CAMPBELL, ROBERT LOUIS III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOUIS
Last Name:CAMPBELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 W CENTRAL AVE STE C5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1510
Mailing Address - Country:US
Mailing Address - Phone:419-407-5399
Mailing Address - Fax:
Practice Address - Street 1:5650 W CENTRAL AVE STE C5
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1510
Practice Address - Country:US
Practice Address - Phone:419-407-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0443583251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH85-1119510Medicaid