1780801936 NPI number — DANIEL DOUGLAS MCCOOL

Table of content: DANIEL DOUGLAS MCCOOL (NPI 1780801936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780801936 NPI number — DANIEL DOUGLAS MCCOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOOL
Provider First Name:
DANIEL
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1780801936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
113 DIVISION
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65753-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-634-3223
Provider Business Mailing Address Fax Number:
417-634-3156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SCHOOL DIST R 3 SPARTA
Provider Second Line Business Practice Location Address:
113 DIVISION
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65753-0160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-634-3223
Provider Business Practice Location Address Fax Number:
417-634-3156
Provider Enumeration Date:
04/19/2007

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: 235Z00000X , with the licence number:  2004008771 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 467564506 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".