Provider Demographics
NPI:1518914985
Name:MCCALL, RONALD ALVIN (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ALVIN
Last Name:MCCALL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 S KIMBROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-3230
Mailing Address - Country:US
Mailing Address - Phone:417-886-1262
Mailing Address - Fax:
Practice Address - Street 1:5946 S KIMBROUGH AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-3230
Practice Address - Country:US
Practice Address - Phone:417-886-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107722363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18942OtherCOX HEALTH PLANS
MO572313OtherHEALTHLINK
MO0600213OtherUNITED HEALTHCARE
MO220024495Medicaid
MOS35583OtherUSPS (W/C)
WA0215424OtherDEPARTMENT OF LABOR WA
MO502277007Medicaid
MO149005OtherBLUE CROSS/CHOICE
MO15083OtherCOX HEALTH PLANS UPI
MO970018741Medicare PIN
MO0600213OtherUNITED HEALTHCARE