Provider Demographics
NPI:1720035561
Name:GRASS VALLEY HEMATOLOGY/ONCOLOGY MED GRP
Entity Type:Organization
Organization Name:GRASS VALLEY HEMATOLOGY/ONCOLOGY MED GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-274-6677
Mailing Address - Street 1:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-1549
Mailing Address - Country:US
Mailing Address - Phone:530-274-6677
Mailing Address - Fax:530-274-6678
Practice Address - Street 1:155 GLASSON WAY
Practice Address - Street 2:SUITE L10
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5723
Practice Address - Country:US
Practice Address - Phone:530-274-6677
Practice Address - Fax:530-274-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00340104OtherRAILROAD MEDICARE PTAN - DAVID L CAMPBELL, MD
1518959188OtherINDIVIDUAL MD NPI# WILLIAM A NEWSOM JR
DF1247OtherRAILROAD MEDICARE PTAN FOR COMPANY CURRENT AS OF 08/2010
1750373239OtherINDIVIDUAL MD NPI# - DAVID CAMPBELL
CAGR0061600Medicaid
CAP00314945OtherRAILROAD MEDICARE PTAN - WILLIAM A NEWSON, JR, MD
ZZZ70159ZOtherPREVIOUS MEDICARE PTAN
CAP00340104OtherRAILROAD MEDICARE PTAN - DAVID L CAMPBELL, MD
ZZZ70159ZOtherPREVIOUS MEDICARE PTAN
CAE95790Medicare UPIN
CA00G0270122Medicare ID - Type UnspecifiedPIN# WM A NEWSOM JR MD
CAP00314945OtherRAILROAD MEDICARE PTAN - WILLIAM A NEWSON, JR, MD
ALZZZ02732ZMedicare ID - Type UnspecifiedNEW MEDICARE PROVIDER#