Provider Demographics
NPI:1831181536
Name:MCVAY, JEREMY A (DPM)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:A
Last Name:MCVAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8580 SCARBOROUGH DR STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7583
Mailing Address - Country:US
Mailing Address - Phone:719-266-5000
Mailing Address - Fax:719-266-6596
Practice Address - Street 1:8580 SCARBOROUGH DR STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7583
Practice Address - Country:US
Practice Address - Phone:719-266-5000
Practice Address - Fax:719-266-6596
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO597213E00000X
CO597213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91677220Medicaid
CO91677220Medicaid
CO4282280001Medicare NSC
COU86252Medicare UPIN