Provider Demographics
NPI:1598164154
Name:MCKERCHER, TOD (ATC)
Entity Type:Individual
Prefix:
First Name:TOD
Middle Name:
Last Name:MCKERCHER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 S PICADILLY ST
Mailing Address - Street 2:EAGLECREST HIGH SCHOOL
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3300
Mailing Address - Country:US
Mailing Address - Phone:720-886-1080
Mailing Address - Fax:
Practice Address - Street 1:5100 S PICADILLY ST
Practice Address - Street 2:EAGLECREST HIGH SCHOOL
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-3300
Practice Address - Country:US
Practice Address - Phone:720-886-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT0000598146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04444162Medicaid