1699723569 NPI number — DR. THOMAS CALL DO

Table of content: DR. THOMAS CALL DO (NPI 1699723569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699723569 NPI number — DR. THOMAS CALL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALL
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1699723569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98 POPLAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACKFOOT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83221-1758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-782-3700
Provider Business Mailing Address Fax Number:
208-782-3765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKFOOT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83221-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-782-3700
Provider Business Practice Location Address Fax Number:
208-782-3765
Provider Enumeration Date:
05/04/2006

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: 207P00000X , with the licence number:  O222 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: O222 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S4026 . This is a "BCID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010150482 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 312944 . This is a "ALTIUS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: S5643 . This is a "BLUE CROSS OLD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010140863 . This is a "BSID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1699723569 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: S6114 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 266530 . This is a "ALTIUS OLD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: Z3649 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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