Provider Demographics
NPI:1891247805
Name:CAMPBELL MEDICAL CARE, LLC
Entity type:Organization
Organization Name:CAMPBELL MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-810-2943
Mailing Address - Street 1:22 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3142
Mailing Address - Country:US
Mailing Address - Phone:860-810-2943
Mailing Address - Fax:860-687-0887
Practice Address - Street 1:22 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3142
Practice Address - Country:US
Practice Address - Phone:860-810-2943
Practice Address - Fax:860-687-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005055363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty