Provider Demographics
NPI:1770622540
Name:MARK E MCCARTHY PC
Entity type:Organization
Organization Name:MARK E MCCARTHY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-417-1163
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-1177
Mailing Address - Country:US
Mailing Address - Phone:520-417-1163
Mailing Address - Fax:520-417-1165
Practice Address - Street 1:4990 E MEDITERRANEAN DR
Practice Address - Street 2:SUITE D
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2494
Practice Address - Country:US
Practice Address - Phone:520-417-1163
Practice Address - Fax:520-417-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24241261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ353269Medicaid
AZ=========OtherTAX IDENTIFICATION
AZ=========OtherTAX IDENTIFICATION