Provider Demographics
NPI:1285610774
Name:CAMPBELL, THOMAS FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:FREDERICK
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRACARE CLINIC RIVER CAMPUS
Mailing Address - Street 2:1200 6TH AVENUE NORTH
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-656-7024
Mailing Address - Fax:320-656-7026
Practice Address - Street 1:1200 6TH AVENUE NORTH
Practice Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-656-7024
Practice Address - Fax:320-656-7026
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25609207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
23232OtherARAZ
0641002OtherPREFERRED ONE
0700012OtherMEDICA PRIMARY
160001740OtherMETRAHEALTH MEDICARE
960980641002OtherPEAK PROVIDER NUMBER
D98325OtherCHOICE PLUS
960980641002OtherPREICH PROVIDER NUMBER
0707104OtherMEDICA CHOICE
107165C280OtherUCARE
32120700OtherWISCONSIN MA
HP13019OtherEMHO
160046617OtherRR MEDICARE
48B94CAOtherBCBS
532865900OtherMN MEDICAL ASSISTANCE
MN532865900Medicaid
0707103OtherSELECT CARE
23232OtherARAZ
MN532865900Medicaid