Provider Demographics
NPI:1477103521
Name:MCCORMICK ORGANIZATION, INC
Entity Type:Organization
Organization Name:MCCORMICK ORGANIZATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-317-7176
Mailing Address - Street 1:299 N ATLANTIC AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-4307
Mailing Address - Country:US
Mailing Address - Phone:352-317-7176
Mailing Address - Fax:
Practice Address - Street 1:1355 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3203
Practice Address - Country:US
Practice Address - Phone:321-613-2969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CBHF1355OtherWE DON'T USE THIS SYSTEM