Provider Demographics
NPI:1912125212
Name:DAVID MICHAEL MCCANCE, LLC
Entity Type:Organization
Organization Name:DAVID MICHAEL MCCANCE, LLC
Other - Org Name:CAROLINA GASTROENTEROLOGY & HEPATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-553-8730
Mailing Address - Street 1:9302 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9142
Mailing Address - Country:US
Mailing Address - Phone:843-553-8730
Mailing Address - Fax:843-553-8767
Practice Address - Street 1:9302 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9142
Practice Address - Country:US
Practice Address - Phone:843-553-8730
Practice Address - Fax:843-553-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1233207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111404919Medicaid
MI1154600105OtherBCBS
SC1275639361Medicaid
MI5460010Medicare ID - Type Unspecified
MI1154600105OtherBCBS
MI111404919Medicaid