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NPI Code Detail

MEDICARE: ZACK MCCALLIE

MEDICARE: ZACK MCCALLIE
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1174120638
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACK MCCALLIE
Provider Business Mailing Address
First Line : 213 NE 10TH ST
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-4825
Country : US
Telephone Number : 971-261-2259
Fax Number :
Provider Business Practice Location Address
First Line : 213 NE 10TH ST
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-4825
Country : US
Telephone Number : 971-261-2259
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2020
Last Update Date : 10/07/2020

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Directions to “ ZACK MCCALLIE ” Practice Location

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