1518914985 NPI number — RONALD ALVIN MCCALL P.A.

Table of content: MIRANDA JOHNSON DO (NPI 1881872539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518914985 NPI number — RONALD ALVIN MCCALL P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALL
Provider First Name:
RONALD
Provider Middle Name:
ALVIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

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:
1518914985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5946 S KIMBROUGH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65810-3230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-886-1262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5946 S KIMBROUGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65810-3230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-886-1262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2006

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: 363AS0400X , with the licence number:  107722 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18942 . This is a "COX HEALTH PLANS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 572313 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0600213 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 220024495 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: S35583 . This is a "USPS (W/C)" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0215424 . This is a "DEPARTMENT OF LABOR WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 502277007 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149005 . This is a "BLUE CROSS/CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 15083 . This is a "COX HEALTH PLANS UPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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