1477536589 NPI number — MRS. LINDA L. MCCALL CNP

Table of content: MRS. LINDA L. MCCALL CNP (NPI 1477536589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477536589 NPI number — MRS. LINDA L. MCCALL CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALL
Provider First Name:
LINDA
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCALL
Provider Other First Name:
LINDA
Provider Other Middle Name:
S.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477536589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 CHATHAM RD
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-787-8870
Provider Business Mailing Address Fax Number:
217-787-6158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 CHATHAM RD
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-787-8870
Provider Business Practice Location Address Fax Number:
217-787-6158
Provider Enumeration Date:
11/22/2005

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: 363LF0000X , with the licence number:  209004577 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 041141945 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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