1821099797 NPI number — DR. RICHARD MCCOLL M.D.

Table of content: DR. RICHARD MCCOLL M.D. (NPI 1821099797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821099797 NPI number — DR. RICHARD MCCOLL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOLL
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1821099797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 W 27TH ST RM 5S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-6208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-351-8255
Provider Business Mailing Address Fax Number:
888-815-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3223 S LOOP 289 STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-1372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-351-8255
Provider Business Practice Location Address Fax Number:
888-815-3583
Provider Enumeration Date:
08/02/2005

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: 2084P0800X , with the licence number:  L1935 , 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: 148935301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260048177 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 742843213 . This is a "TAX ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8465N0 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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