1538150206 NPI number — MR. DARIN MICHAEL MCCANN P.A.-C

Table of content: MR. DARIN MICHAEL MCCANN P.A.-C (NPI 1538150206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538150206 NPI number — MR. DARIN MICHAEL MCCANN P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCANN
Provider First Name:
DARIN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
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:
1538150206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 MARKETPLACE PLZ STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEAMBOAT SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80487-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-879-6663
Provider Business Mailing Address Fax Number:
970-871-1234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 COLLEGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK SPRINGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82901-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-448-3220
Provider Business Practice Location Address Fax Number:
970-871-1234
Provider Enumeration Date:
11/02/2005

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: 363AM0700X , with the licence number:  PA07484 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 278 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 278 . This is a "WY LICENSE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 44833245 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00266055 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1538150206 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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