Provider Demographics
NPI:1952304669
Name:MCCALL'S ORTHOTIC AND PROSTHETIC
Entity Type:Organization
Organization Name:MCCALL'S ORTHOTIC AND PROSTHETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRACTIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SIXSMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:LPO
Authorized Official - Phone:727-327-5000
Mailing Address - Street 1:5639 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2105
Mailing Address - Country:US
Mailing Address - Phone:727-327-5000
Mailing Address - Fax:727-527-6661
Practice Address - Street 1:5639 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2105
Practice Address - Country:US
Practice Address - Phone:727-327-5000
Practice Address - Fax:727-527-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL028335500Medicaid
FL0390260001Medicare NSC