Provider Demographics
NPI:1700899416
Name:CAMPBELL, KENNETH JR (CSA,SA-C,LSA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:CSA,SA-C,LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 71ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1802
Mailing Address - Country:US
Mailing Address - Phone:806-798-3380
Mailing Address - Fax:806-792-9180
Practice Address - Street 1:5506-71ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-798-3380
Practice Address - Fax:806-792-9180
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist