1154546281 NPI number — KELLY SHANNAN MCCARTHY CDMS

Table of content: KELLY SHANNAN MCCARTHY CDMS (NPI 1154546281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154546281 NPI number — KELLY SHANNAN MCCARTHY CDMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
KELLY
Provider Middle Name:
SHANNAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CDMS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCARTHY
Provider Other First Name:
KELLY
Provider Other Middle Name:
SHANNAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154546281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4448 ANCHORAGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLIARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43026-7815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-876-9712
Provider Business Mailing Address Fax Number:
614-876-9713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4448 ANCHORAGE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLIARD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43026-7815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-876-9712
Provider Business Practice Location Address Fax Number:
614-876-9713
Provider Enumeration Date:
04/16/2007

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: 171M00000X , with the licence number:  J009638 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: J009638 . This is a "CMDS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".