Provider Demographics
NPI:1578540787
Name:CAMPBELL, JULIUS E III (CRNA)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:E
Last Name:CAMPBELL
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WINDY COVE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-8857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 WINDY COVE LN
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:SC
Practice Address - Zip Code:29130-8857
Practice Address - Country:US
Practice Address - Phone:803-713-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26104367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00119651OtherMEDICARE RR ID#
CA8394OtherMEDICARE RR GROUP
SCAN0259Medicaid
420048Medicare Oscar/Certification
SCP00119651OtherMEDICARE RR ID#