Provider Demographics
NPI:1790740942
Name:MADSEN CALCUTT, DANA (DO)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MADSEN CALCUTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:EASTERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1014 MADISON ST
Mailing Address - Street 2:OB/GYN ASSOCIATES
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3458
Mailing Address - Country:US
Mailing Address - Phone:573-632-5510
Mailing Address - Fax:573-632-5810
Practice Address - Street 1:1014 MADISON ST
Practice Address - Street 2:OB/GYN ASSOCIATES
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3458
Practice Address - Country:US
Practice Address - Phone:573-632-5510
Practice Address - Fax:573-632-5810
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6N76207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124972OtherCCN
C15354OtherRR MEDICARE GROUP
1124972OtherFIRST HEALTH
2576582OtherCIGNA
F69930OtherMERCY
160042445OtherRR MEDICARE
3854OtherBLUE CROSS BLUE SHIELD
MO247819824Medicaid
278924OtherHEALTHLINK
2576582OtherCIGNA
MO247819824Medicaid
278924OtherHEALTHLINK