MEDICARE: MR. MICHAEL ROY MCCARTER II PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	PA2014-0013	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588654214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ROY MCCARTER II PA-C

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-6770
Fax Number	:	505-923-5354

Provider Business Practice Location Address
First Line	:	8300 CONSTITUTION AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7613
Country	:	US
Telephone Number	:	505-253-6100
Fax Number	:	505-559-6479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	03/28/2016

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