Provider Demographics
NPI:1952594269
Name:MCLEOD, CALVIN JEROME
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:JEROME
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BEAVER CREEK RD
Mailing Address - Street 2:APT #903
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-8100
Mailing Address - Country:US
Mailing Address - Phone:740-703-2134
Mailing Address - Fax:
Practice Address - Street 1:601 BEAVER CREEK RD
Practice Address - Street 2:APT #903
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8100
Practice Address - Country:US
Practice Address - Phone:740-703-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122203164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse