Provider Demographics
NPI:1548242894
Name:CAMPBELL, CAROLINE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 HOSPITAL DR
Mailing Address - Street 2:FAMILY HEALTH ASSOCIATES, P.C.
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4426
Mailing Address - Country:US
Mailing Address - Phone:417-532-7850
Mailing Address - Fax:417-532-2451
Practice Address - Street 1:341 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9217
Practice Address - Country:US
Practice Address - Phone:417-532-7850
Practice Address - Fax:417-532-2451
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203854500Medicaid
G78677Medicare UPIN