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NPI Code Detail

MEDICARE: BOBIE CALICUTT

MEDICARE:   BOBIE  CALICUTT
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
1172V00000XCommunity Health WorkerMO
2172V00000XCommunity Health WorkerT208137023MO

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 : 1730631508
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBIE CALICUTT
Provider Business Mailing Address
First Line : 2055 CRAIGSHIRE RD STE 420F
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4043
Country : US
Telephone Number : 816-400-4276
Fax Number : 314-887-7004
Provider Business Practice Location Address
First Line : 2055 CRAIGSHIRE RD STE 420F
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4043
Country : US
Telephone Number : 816-400-4276
Fax Number : 314-887-7004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2016
Last Update Date : 06/24/2021

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Directions to “ BOBIE CALICUTT ” Practice Location

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