Provider Demographics
NPI:1922031509
Name:MARK S. CALKINS, MD, PA.
Entity Type:Organization
Organization Name:MARK S. CALKINS, MD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-729-2727
Mailing Address - Street 1:550 TWIN CITIES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1050
Mailing Address - Country:US
Mailing Address - Phone:850-729-2727
Mailing Address - Fax:850-729-7066
Practice Address - Street 1:550 TWIN CITIES BLVD STE A
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1050
Practice Address - Country:US
Practice Address - Phone:850-729-2727
Practice Address - Fax:850-729-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39537207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0560010001Medicare NSC