Provider Demographics
NPI:1487680237
Name:CAMPBELL, IRENE BERNADETTE (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:BERNADETTE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2824
Mailing Address - Country:US
Mailing Address - Phone:615-790-6060
Mailing Address - Fax:615-790-1123
Practice Address - Street 1:600 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2824
Practice Address - Country:US
Practice Address - Phone:615-790-6060
Practice Address - Fax:615-790-1123
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM446213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352232Medicaid
TN480023738OtherRAILROAD MEDICARE
TN4124344OtherBLUE CROSS BLUE SHIELD
TNU33851Medicare UPIN
TN5929110001Medicare NSC
TN4124344OtherBLUE CROSS BLUE SHIELD