Healthcare Provider Details

I. General information

NPI: 1750091658
Provider Name (Legal Business Name): ERIC MCCALLISTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29099 HEALTH CAMPUS DR STE 290
WESTLAKE OH
44145-5280
US

IV. Provider business mailing address

PO BOX 450807
WESTLAKE OH
44145-0617
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-1999
  • Fax: 440-835-1996
Mailing address:
  • Phone: 440-235-8484
  • Fax: 440-235-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARLENA C MURRAY
Title or Position: BILLING
Credential: CBCS
Phone: 440-235-8484