Provider Demographics
NPI:1669441010
Name:CAMPBELL EAR, NOSE & THROAT, PA
Entity Type:Organization
Organization Name:CAMPBELL EAR, NOSE & THROAT, PA
Other - Org Name:CAMPBELL EAR, NOSE AND THROAT, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-1038
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-1246
Mailing Address - Country:US
Mailing Address - Phone:910-738-1038
Mailing Address - Fax:910-738-1472
Practice Address - Street 1:4760 INDEPENDENCE DRIVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2835
Practice Address - Country:US
Practice Address - Phone:910-738-1038
Practice Address - Fax:910-738-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty