=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629667761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MCCALL D SIMS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2021
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E HAMPDEN AVE STE 200
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80113-2885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-783-8844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 674 TOWNSHIP ROAD 201
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43910-7947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-381-4683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | PA.0008547
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------