Healthcare Provider Details

I. General information

NPI: 1144310020
Provider Name (Legal Business Name): MICHELLE C MCCALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BIRCH ST
HELENA MT
59601-0617
US

IV. Provider business mailing address

PO BOX 5179
HELENA MT
59604-5179
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-2977
  • Fax: 406-443-2960
Mailing address:
  • Phone: 406-495-7265
  • Fax: 406-443-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number9560
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0140437
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: