1538451901 NPI number — REBECCA S. MCCALL

Table of content: REBECCA S. MCCALL (NPI 1538451901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538451901 NPI number — REBECCA S. MCCALL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCALL
Provider First Name:
REBECCA
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
REBECCA
Provider Other Middle Name:
S.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538451901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAMEGO
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66547-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-844-0078
Provider Business Mailing Address Fax Number:
785-456-9520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66547-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-844-2440
Provider Business Practice Location Address Fax Number:
785-456-9520
Provider Enumeration Date:
05/04/2011

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: 251B00000X , with the licence number:  90-0715502 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200733740A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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