Provider Demographics
NPI:1558547356
Name:RYAN J. MCCALLA, DPM, PA
Entity Type:Organization
Organization Name:RYAN J. MCCALLA, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCALLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, PA
Authorized Official - Phone:785-354-7608
Mailing Address - Street 1:2010 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1406
Mailing Address - Country:US
Mailing Address - Phone:785-354-7608
Mailing Address - Fax:785-354-4202
Practice Address - Street 1:2010 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1406
Practice Address - Country:US
Practice Address - Phone:785-354-7608
Practice Address - Fax:785-354-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114209OtherBLUE CROSS BLUE SHIELD GROUP NUMBER
KS114209OtherBLUE CROSS BLUE SHIELD GROUP NUMBER
KS114026Medicare PIN
KS1263350001Medicare NSC