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NPI Code Detail

MEDICARE: DR. SHANE ERIN MCCARTHY D.O.

MEDICARE: DR. SHANE ERIN MCCARTHY D.O.
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
1207Q00000XFamily Medicine PhysicianA-1212-03NM
2207Q00000XFamily Medicine Physician40209CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629073150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANE ERIN MCCARTHY D.O.
Provider Business Mailing Address
First Line : 2685 DUBLIN BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-1358
Country : US
Telephone Number : 719-592-9890
Fax Number : 719-264-7810
Provider Business Practice Location Address
First Line : 2685 DUBLIN BLVD
Second Line : 3RD FLOOR
City : COLORADO SPRINGS
State : CO
Zip : 80918-1358
Country : US
Telephone Number : 719-592-9890
Fax Number : 719-592-9890
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 05/29/2008

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