1073538575 NPI number — JANE M MACKALL CCC-A, MA

Table of content: JANE M MACKALL CCC-A, MA (NPI 1073538575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073538575 NPI number — JANE M MACKALL CCC-A, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKALL
Provider First Name:
JANE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-A, MA
Provider Gender Code:
F

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:
1073538575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 METROHEALTH DR
Provider Second Line Business Mailing Address:
MHMC-OTOLARYNGOLOGY
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44109-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-778-7748
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 METROHEALTH DR
Provider Second Line Business Practice Location Address:
MHMC-OTOLARYNGOLOGY
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44109-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-778-7748
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A-00673 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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