Healthcare Provider Details

I. General information

NPI: 1700881042
Provider Name (Legal Business Name): EILEEN LYNN MCCALLUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EILEEN MCCALLUM MD

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 CALIFORNIA ST SUITE A
REDDING CA
96001-1943
US

IV. Provider business mailing address

1920 CALIFORNIA ST SUITE A
REDDING CA
96001-1943
US

V. Phone/Fax

Practice location:
  • Phone: 530-247-7070
  • Fax: 530-244-7246
Mailing address:
  • Phone: 530-247-7070
  • Fax: 530-244-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA055135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: