1558309765 NPI number — SHANE D. MCCURDY LSCSW

Table of content: SHANE D. MCCURDY LSCSW (NPI 1558309765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558309765 NPI number — SHANE D. MCCURDY LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCURDY
Provider First Name:
SHANE
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSCSW
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:
1558309765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9415 EAST HARRY, BUILDING 3
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-202-2110
Provider Business Mailing Address Fax Number:
316-226-8648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9415 E HARRY ST
Provider Second Line Business Practice Location Address:
STE 306
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67207-5077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-202-2110
Provider Business Practice Location Address Fax Number:
316-226-8648
Provider Enumeration Date:
06/02/2006

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: 104100000X , with the licence number:  5670 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 3811 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201443 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 8966 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com