1194898346 NPI number — DAVID M MCKALIP MD PA

Table of content: (NPI 1194898346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194898346 NPI number — DAVID M MCKALIP MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID M MCKALIP MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194898346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1955 1ST AVENUE NORTH
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAINT PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33713-8907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-822-3500
Provider Business Mailing Address Fax Number:
727-822-3228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1955 1ST AVENUE NORTH
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33713-8907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-822-3500
Provider Business Practice Location Address Fax Number:
727-822-3228
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKALIP
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-822-3500

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  ME81052 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 217481 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2490288 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7373130 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 57962 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259784500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5790719 . This is a "AETNA MANAGED CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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