Provider Demographics
NPI:1467783696
Name:CAMPUS CLINICS, LLC
Entity Type:Organization
Organization Name:CAMPUS CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-351-2412
Mailing Address - Street 1:1901 10TH AVE
Mailing Address - Street 2:CASSIDY HALL
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80639-5545
Mailing Address - Country:US
Mailing Address - Phone:970-351-2412
Mailing Address - Fax:
Practice Address - Street 1:1901 10TH AVE, CAMPUS BOX 37
Practice Address - Street 2:CASSIDY HALL
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639
Practice Address - Country:US
Practice Address - Phone:970-351-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5112111N00000X
CO32068207Q00000X
CO2468363A00000X
CO184924363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty