Provider Demographics
NPI:1649244427
Name:LLOYD CALLAWAY, JR., M.D., S.C.
Entity Type:Organization
Organization Name:LLOYD CALLAWAY, JR., M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAWAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:815-777-6910
Mailing Address - Street 1:10988 BARTEL BLVD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-8216
Mailing Address - Country:US
Mailing Address - Phone:815-777-6910
Mailing Address - Fax:815-777-6905
Practice Address - Street 1:10988 BARTEL BLVD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-8216
Practice Address - Country:US
Practice Address - Phone:815-777-6910
Practice Address - Fax:815-777-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI8430Medicare PIN
IL902280Medicare PIN