Provider Demographics
NPI:1588993018
Name:DPMCALLNRID LLC
Entity type:Organization
Organization Name:DPMCALLNRID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-390-9631
Mailing Address - Street 1:718 BEULAHS LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2340
Mailing Address - Country:US
Mailing Address - Phone:208-390-9631
Mailing Address - Fax:
Practice Address - Street 1:718 BEULAHS LN
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2340
Practice Address - Country:US
Practice Address - Phone:208-390-9631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-85213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDT44250Medicare UPIN