Healthcare Provider Details

I. General information

NPI: 1376880948
Provider Name (Legal Business Name): MEGAN CALLIS EMT-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HIGHWAY 69 N
HARTFORD KY
42347-9785
US

IV. Provider business mailing address

985 CROWE ST
BEAVER DAM KY
42320-1744
US

V. Phone/Fax

Practice location:
  • Phone: 270-298-4415
  • Fax:
Mailing address:
  • Phone: 270-256-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1051592, 3776-P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: