1245260132 NPI number — MAUREEN MCCORMACK MD

Table of content: MAUREEN MCCORMACK MD (NPI 1245260132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245260132 NPI number — MAUREEN MCCORMACK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCORMACK
Provider First Name:
MAUREEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1245260132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 PALOMINO LN
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89106-4894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-759-8600
Provider Business Mailing Address Fax Number:
702-384-1815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 PALOMINO LN
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89106-4894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-759-8600
Provider Business Practice Location Address Fax Number:
702-384-1815
Provider Enumeration Date:
07/04/2006

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: 2085R0202X , with the licence number:  10628 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1245260132 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200471100A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01168773 . This is a "RR MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 100502381 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com