Provider Demographics
NPI:1467631903
Name:JEANNIE M MC CANCE MD PLLC
Entity Type:Organization
Organization Name:JEANNIE M MC CANCE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MC CANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-687-1634
Mailing Address - Street 1:826 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5124
Mailing Address - Country:US
Mailing Address - Phone:918-687-1634
Mailing Address - Fax:918-398-4408
Practice Address - Street 1:826 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5124
Practice Address - Country:US
Practice Address - Phone:918-687-1634
Practice Address - Fax:918-398-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16881302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization