Provider Demographics
NPI:1922201227
Name:DR GREG J MCCARTHY PC
Entity Type:Organization
Organization Name:DR GREG J MCCARTHY PC
Other - Org Name:SIOUXLAND PODIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:712-255-1621
Mailing Address - Street 1:2916 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2429
Mailing Address - Country:US
Mailing Address - Phone:712-255-1621
Mailing Address - Fax:712-255-1389
Practice Address - Street 1:2916 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2429
Practice Address - Country:US
Practice Address - Phone:712-255-1621
Practice Address - Fax:712-255-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00575213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0435834Medicaid
CB4878Medicare PIN
SDS8671Medicare PIN
IAI7290Medicare UPIN
4176460001Medicare NSC
NE099383Medicare PIN