1528117835 NPI number — DR. MICHAEL MCCORMICK

Table of content: DR. MICHAEL MCCORMICK (NPI 1528117835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528117835 NPI number — DR. MICHAEL MCCORMICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCORMICK
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1528117835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12701 RESEARCH BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-4386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-258-2020
Provider Business Mailing Address Fax Number:
512-258-7835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12701 RESEARCH BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78759-4386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-258-2020
Provider Business Practice Location Address Fax Number:
512-258-7835
Provider Enumeration Date:
01/09/2007

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: 152W00000X , with the licence number:  4838TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 82909E . This is a "BCBS ID NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1216022002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103130401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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