1265535827 NPI number — STEVEN TREVOR MCCROREY MD

Table of content: STEVEN TREVOR MCCROREY MD (NPI 1265535827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265535827 NPI number — STEVEN TREVOR MCCROREY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCROREY
Provider First Name:
STEVEN
Provider Middle Name:
TREVOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1265535827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 EAST BOONE AD 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99258-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-313-4066
Provider Business Mailing Address Fax Number:
509-313-5516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 EAST SHARP AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99258-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-313-4066
Provider Business Practice Location Address Fax Number:
503-313-5516
Provider Enumeration Date:
09/07/2006

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: 207Q00000X , with the licence number:  MD00037220 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8935357 . This is a "CRIMEVICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911019392 . This is a "COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8242596 . This is a "CHPW" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8242596 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805582100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156522 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: KQ324 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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