Provider Demographics
NPI:1811917628
Name:MICHAEL H MCCORMICK M D P A
Entity type:Organization
Organization Name:MICHAEL H MCCORMICK M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-769-2417
Mailing Address - Street 1:2202 STATE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7601
Mailing Address - Country:US
Mailing Address - Phone:850-769-2417
Mailing Address - Fax:850-784-1144
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-769-2417
Practice Address - Fax:850-784-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051595207X00000X
FLME104621207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407885882OtherMEDICARE NPI PURVIS
FL058854700Medicaid
FL1346270881OtherMICHAEL L ADAMS MD NPI
FL14798OtherBLUE SHIELD
FL1982677936OtherMCCORMICK NPI NUMBER
FL200012815OtherRAILROAD MEDICARE
FL37186YOtherMEDICARE
FL1477505717OtherNPI FOR DEBRA J KELLEY ARNP-C
FLP00420317OtherRAILROAD MEDICARE PURVIS
FL1477505717OtherNPI FOR DEBRA J KELLEY ARNP-C
FL14798ZMedicare PIN
FL1982677936OtherMCCORMICK NPI NUMBER
FLK4964Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
FLDG1715Medicare PIN