1811917628 NPI number — MICHAEL H MCCORMICK M D P A

Table of content: (NPI 1811917628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811917628 NPI number — MICHAEL H MCCORMICK M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL H MCCORMICK M D P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1811917628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 STATE AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32405-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-769-2417
Provider Business Mailing Address Fax Number:
850-784-1144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 STATE AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PANAMA CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32405-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-769-2417
Provider Business Practice Location Address Fax Number:
850-784-1144
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
DORIS
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
MEDICAL ASSISTANT
Authorized Official Telephone Number:
850-769-2417

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  ME0051595 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: ME104621 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1407885882 . This is a "MEDICARE NPI PURVIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 058854700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1346270881 . This is a "MICHAEL L ADAMS MD NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 14798 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1982677936 . This is a "MCCORMICK NPI NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200012815 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 37186Y . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1477505717 . This is a "NPI FOR DEBRA J KELLEY ARNP-C" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00420317 . This is a "RAILROAD MEDICARE PURVIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com