Provider Demographics
NPI:1750822771
Name:CAMPBELL, BILLY RAY III (CPED, CFO)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:RAY
Last Name:CAMPBELL
Suffix:III
Gender:M
Credentials:CPED, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 IMPERATOR LN UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7707
Mailing Address - Country:US
Mailing Address - Phone:502-593-6119
Mailing Address - Fax:
Practice Address - Street 1:315 E BROADWAY STE 1400
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3700
Practice Address - Country:US
Practice Address - Phone:502-629-8640
Practice Address - Fax:502-629-5527
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCPED3595224L00000X
KYCFO04010225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist