Healthcare Provider Details

I. General information

NPI: 1629667761
Provider Name (Legal Business Name): MCCALL D SIMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E HAMPDEN AVE STE 200
ENGLEWOOD CO
80113-2885
US

IV. Provider business mailing address

674 TOWNSHIP ROAD 201
BLOOMINGDALE OH
43910-7947
US

V. Phone/Fax

Practice location:
  • Phone: 303-783-8844
  • Fax:
Mailing address:
  • Phone: 740-381-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0008547
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: