Basic Information
| Provider Information | |||||||||
| NPI: | 1174586457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 E GRAY ST | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085847525 | ||||||||
| FaxNumber: | 5025890849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 28014 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 000051983J | 01 | KY | HUMANA- NORTON LEATHERMAN SPINE CENTER | OTHER | 000000049467 | 01 | KY | ANTHEM (SPINE INSTITUTE) | OTHER | 00533158 | 01 | KY | MEDICARE- NORTON LEATHERMAN SPINE CENTER | OTHER | 3728039000 | 01 | KY | PASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER | OTHER | 50024963 | 01 | KY | PASSPORT- NORTON LEATHERMAN SPINE CENTER | OTHER | 8856267 | 01 | KY | CIGNA- NORTON LEATHERMAN SPINE CENTER | OTHER | 64280142 | 05 | KY | MEDICAID | 000000049352 | 01 | KY | ANTHEM (UNIVERSITY ORTHOP | OTHER | 000000628569 | 01 | KY | ANTHEM- NORTON LEATHERMAN SPINE CENTER | OTHER | 1054523 | 01 | KY | PASSPORT (SPINE INSTITUTE | OTHER | 2432609000 | 01 | KY | PASSPORT ADVANTAGE (UNIVE | OTHER | 36123 | 01 | KY | CIGNA (SPINE INSTITUTE) | OTHER | 163722400 | 01 | US DEPT OF LABOR | OTHER | 200027304 | 01 | KY | RAILROAD MEDICARE | OTHER | 200103760 | 01 | KY | HEALTHY INDIANA PLAN- COMMUNITY MEDICAL ASSOCIATES | OTHER | 2433677000 | 01 | KY | PASSPORT ADVANTAGE (SPINE | OTHER | P00764026 | 01 | KY | RAILROAD MEDICARE- NORTON LEATHERMAN SPINE CENTER | OTHER | 1049632 | 01 | KY | PASSPORT (UNIVERSITY ORT | OTHER | 200103760A | 05 | IN | MEDICAID | 667790 | 01 | KY | CIGNA (UNIVERSITY ORTHOPA | OTHER | N293520 | 01 | KY | HARMONY (SPINE INSTITUTE) | OTHER | 200103760 | 05 | IN | MEDICAID |