Healthcare Provider Details

I. General information

NPI: 1982113585
Provider Name (Legal Business Name): JOSHUA CACHE MCCALLUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SIMPSON AVE STE 101
ABERDEEN WA
98520-4333
US

IV. Provider business mailing address

921 14TH AVENUE
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-612-0012
  • Fax:
Mailing address:
  • Phone: 360-423-0203
  • Fax: 360-577-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: