1285628750 NPI number — FRANCIS R MCCULLY JR. M.D.

Table of content: FRANCIS R MCCULLY JR. M.D. (NPI 1285628750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285628750 NPI number — FRANCIS R MCCULLY JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCULLY
Provider First Name:
FRANCIS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
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:
1285628750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 LAUREL AVE # N304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37916-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-766-6870
Provider Business Mailing Address Fax Number:
865-766-0133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1468 HILLTOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER SPRINGS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19425-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-766-6870
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2005

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: 2085R0202X , with the licence number:  MD055767L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: G88632 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0071574400002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285628750 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50084014 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 685363 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".