NPIMap

Organization Active NPI

Campbell Clinic PC

  • Durable Medical Equipment & Medical Supplies
  • Bristol, TN
National Provider Identifier
1104711514
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
CAMPBELL CLINIC PC
Practice address
1 Medical Park Blvd Ste 300E
Bristol, TN 37620-7497
Phone
(423) 844-6450
NPI assigned
Jun 9, 2025
Organization subpart
Yes
Parent organization
CAMPBELL CLINIC PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Shumate
Title
Ceo
Phone
(901) 759-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1 Medical Park Blvd Ste 300E
Bristol, TN 37620-7497

Mailing address

1400 S Germantown Rd
Germantown, TN 38138-2205
Phone (901) 759-1003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250708000993 TN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 9638082076 Practice locations: Bristol, TN

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Campbell Clinic25 organizations share this tax ID, including this one
Part of
Campbell Clinic

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1104711514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GERMANTOWN RD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382205",
            "telephone_number": "901-759-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD STE 300E",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207497",
            "telephone_number": "423-844-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELL CLINIC PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAMPBELL CLINIC PC",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "SHUMATE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-759-3100"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.