1619101755 NPI number — MS. MARY GENEVIEVE MCCARTHY PNP

Table of content: MS. MARY GENEVIEVE MCCARTHY PNP (NPI 1619101755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619101755 NPI number — MS. MARY GENEVIEVE MCCARTHY PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
MARY
Provider Middle Name:
GENEVIEVE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619101755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10944 LOMA DE COLOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79934-3584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-822-8786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1733 CURIE DR STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-532-2985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  TX537114 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0626343-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".