1629006036 NPI number — TYRONE LEE MCCALL MD

Table of content: (NPI 1285618363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629006036 NPI number — TYRONE LEE MCCALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALL
Provider First Name:
TYRONE
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1629006036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 730486
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-0486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-692-0146
Provider Business Mailing Address Fax Number:
214-692-1698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10740 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-692-0146
Provider Business Practice Location Address Fax Number:
214-692-1698
Provider Enumeration Date:
06/28/2006

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: 207W00000X , with the licence number:  K2751 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207WX0120X , with the licence number: K2751 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 154304303 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8X1373 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 186667501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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