=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952597601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LINDA A MACALLISTER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2007
-----------------------------------------------------
Last Update Date | 09/17/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13212 FELDSPAR AVE
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33981-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-662-0603
-----------------------------------------------------
Fax | 941-697-9500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27102
-----------------------------------------------------
City | EL JOBEAN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33927-7102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-662-0603
-----------------------------------------------------
Fax | 941-697-9500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------