Provider Demographics
NPI:1649356288
Name:SD MCCORMICK LLC
Entity type:Organization
Organization Name:SD MCCORMICK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MNGR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-313-2543
Mailing Address - Street 1:3401 W AIRPORT FWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5924
Mailing Address - Country:US
Mailing Address - Phone:972-313-2543
Mailing Address - Fax:972-313-2544
Practice Address - Street 1:3401 W AIRPORT FWY
Practice Address - Street 2:SUITE 106
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5924
Practice Address - Country:US
Practice Address - Phone:972-313-2543
Practice Address - Fax:972-313-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20244237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199799101Medicaid