Provider Demographics
NPI:1316982093
Name:CALABRO, JOHN P (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:CALABRO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241353
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5353
Mailing Address - Country:US
Mailing Address - Phone:402-398-9243
Mailing Address - Fax:402-398-9253
Practice Address - Street 1:8005 FARNAM DR
Practice Address - Street 2:SUITE 305
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3426
Practice Address - Country:US
Practice Address - Phone:402-398-9243
Practice Address - Fax:402-398-9253
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
277044OtherMEDICARE INDIVIDUAL PIN
NE39170OtherBCBS
IA97850OtherBCBS
P00154888OtherRR MEDICARE
P00154888OtherRR MEDICARE
NE098770Medicare PIN