Provider Demographics
NPI:1629276605
Name:DR. MICHAEL A. CAMPBELL
Entity Type:Organization
Organization Name:DR. MICHAEL A. CAMPBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-681-6682
Mailing Address - Street 1:10 HOSPITAL CENTER CMNS
Mailing Address - Street 2:STE. 100
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2839
Mailing Address - Country:US
Mailing Address - Phone:843-681-6682
Mailing Address - Fax:843-681-9582
Practice Address - Street 1:10 HOSPITAL CENTER CMNS
Practice Address - Street 2:STE. 100
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2839
Practice Address - Country:US
Practice Address - Phone:843-681-6682
Practice Address - Fax:843-681-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3063OtherMEDICARE GROUP NUMBER
SC410008055OtherRR MEDICARE