1275954257 NPI number — MR. GEORGE G MCKAMY SLP

Table of content: MR. GEORGE G MCKAMY SLP (NPI 1275954257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275954257 NPI number — MR. GEORGE G MCKAMY SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKAMY
Provider First Name:
GEORGE
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SLP
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:
1275954257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 PERKINS DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005-3248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-647-3773
Provider Business Mailing Address Fax Number:
575-647-3777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1681 HICKORY LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88005-6502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-647-3773
Provider Business Practice Location Address Fax Number:
575-647-3777
Provider Enumeration Date:
12/18/2013

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:  SLP6586 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21883734 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com