Provider Demographics
NPI:1942436969
Name:WINFIELD CAMPBELL M.D., PA
Entity Type:Organization
Organization Name:WINFIELD CAMPBELL M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-647-7720
Mailing Address - Street 1:19770 KINGSLAND BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1031
Mailing Address - Country:US
Mailing Address - Phone:281-647-7720
Mailing Address - Fax:
Practice Address - Street 1:19770 KINGSLAND BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1031
Practice Address - Country:US
Practice Address - Phone:281-647-7720
Practice Address - Fax:281-647-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9900207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0080SKOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX0080SKOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX6263360001Medicare NSC