Provider Demographics
NPI:1225043888
Name:MCCALLA, JO ANNA (MD)
Entity Type:Individual
Prefix:
First Name:JO ANNA
Middle Name:
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3537
Mailing Address - Country:US
Mailing Address - Phone:785-229-8341
Mailing Address - Fax:785-229-8419
Practice Address - Street 1:1301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3537
Practice Address - Country:US
Practice Address - Phone:785-229-8341
Practice Address - Fax:785-229-8419
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST02201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL472301OtherHEALTHLINK
IL080174568OtherRAILROAD MEDICARE
IL0361038271Medicaid
IL070136OtherHEALTH ALLIANCE
IL7215059OtherBCBS PPO
ILIL01M1OtherJOHN DEERE
ILIL01M1OtherJOHN DEERE
IL7215059OtherBCBS PPO