Healthcare Provider Details

I. General information

NPI: 1356780407
Provider Name (Legal Business Name): COLIN MCCALLA B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W 5TH AVE
DENVER CO
80204-5102
US

IV. Provider business mailing address

77 W 5TH AVE
DENVER CO
80204-5102
US

V. Phone/Fax

Practice location:
  • Phone: 303-412-3912
  • Fax: 303-412-3405
Mailing address:
  • Phone: 303-412-3912
  • Fax: 303-412-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: