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NPI Code Detail

MEDICARE: MARY ELIZABETH MCCALL CRNA

MEDICARE: MARY ELIZABETH MCCALL CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist3084AKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114929759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH MCCALL CRNA
Provider Business Mailing Address
First Line : 3320 TATES CREEK RD
Second Line : SUITE 204
City : LEXINGTON
State : KY
Zip : 40502-3400
Country : US
Telephone Number : 859-268-1030
Fax Number : 859-269-4120
Provider Business Practice Location Address
First Line : 310 S LIMESTONE
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-3008
Country : US
Telephone Number : 859-252-6612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 07/08/2007

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