Provider Demographics
NPI:1992420079
Name:MCCALL, NATHAN TIMOTHY (TRANSPORTATION)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:TIMOTHY
Last Name:MCCALL
Suffix:
Gender:M
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 FATHER CARUSO DR APT 4407
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1007
Mailing Address - Country:US
Mailing Address - Phone:216-931-6792
Mailing Address - Fax:
Practice Address - Street 1:5900 FATHER CARUSO DR APT 4407
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1007
Practice Address - Country:US
Practice Address - Phone:216-931-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRM770969172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0219546Medicaid