1447518063 NPI number — MARK MCDONALD P.T., P.C.

Table of content: (NPI 1447518063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447518063 NPI number — MARK MCDONALD P.T., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK MCDONALD P.T., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1447518063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80751-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-522-7743
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 W LARIMER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEMING
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-265-4878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
970-522-7743

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P6403 . This is a "BLUE CROSS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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