Provider Demographics
NPI:1346556909
Name:C L CAMBELL LLC
Entity Type:Organization
Organization Name:C L CAMBELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-654-4192
Mailing Address - Street 1:728 W 100 S STE 1
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3764
Mailing Address - Country:US
Mailing Address - Phone:435-654-4192
Mailing Address - Fax:435-654-4067
Practice Address - Street 1:728 W 100 S STE 1
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3764
Practice Address - Country:US
Practice Address - Phone:435-654-4192
Practice Address - Fax:435-654-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT852049924405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528867559-002Medicaid
S57930Medicare UPIN
U000007916Medicare PIN