1801887534 NPI number — DR. ROGER C MCCARTNEY OD

Table of content: DR. ROGER C MCCARTNEY OD (NPI 1801887534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801887534 NPI number — DR. ROGER C MCCARTNEY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTNEY
Provider First Name:
ROGER
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1801887534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S 23RD ST
Provider Second Line Business Mailing Address:
PO BOX 312
Provider Business Mailing Address City Name:
ORD
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68862-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-728-3420
Provider Business Mailing Address Fax Number:
308-728-5908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1511 M ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORD
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68862-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-728-3229
Provider Business Practice Location Address Fax Number:
308-728-5908
Provider Enumeration Date:
11/02/2005

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: 152W00000X , with the licence number:  809 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06726 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1245308253 . This is a "MEDICARE NSC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47063736300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0382230001 . This is a "DME MAC" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47063736302 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 098964 . This is a "MEDICARE GROUP" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".