Provider Demographics
NPI:1740436179
Name:CAMPBELL PEDORTHICS, LLC
Entity type:Organization
Organization Name:CAMPBELL PEDORTHICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:804-794-0070
Mailing Address - Street 1:11306 EASTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-2480
Mailing Address - Country:US
Mailing Address - Phone:804-794-0070
Mailing Address - Fax:804-794-0072
Practice Address - Street 1:1520 HUGUENOT RD
Practice Address - Street 2:SUITE 114
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2477
Practice Address - Country:US
Practice Address - Phone:804-794-0070
Practice Address - Fax:804-794-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPED0774174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6086510001Medicare NSC