Provider Demographics
NPI:1770529190
Name:CAMPBELL, MELVIN ALLEN (MD FACP)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:ALLEN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-0287
Mailing Address - Country:US
Mailing Address - Phone:402-387-1900
Mailing Address - Fax:402-387-0139
Practice Address - Street 1:913 E ZERO ST
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-0287
Practice Address - Country:US
Practice Address - Phone:402-387-1900
Practice Address - Fax:402-387-0139
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080028209OtherRR MEDICARE PROVIDER
12836OtherNE LICENSE
NE47055072313Medicaid
SD7702980Medicaid
02754OtherBCBS NE
02754OtherBCBS NE
NE47055072313Medicaid
B68098Medicare UPIN