Healthcare Provider Details

I. General information

NPI: 1770622540
Provider Name (Legal Business Name): MARK E MCCARTHY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 E MEDITERRANEAN DR SUITE D
SIERRA VISTA AZ
85635-2494
US

IV. Provider business mailing address

PO BOX 1177
HEREFORD AZ
85615-1177
US

V. Phone/Fax

Practice location:
  • Phone: 520-417-1163
  • Fax: 520-417-1165
Mailing address:
  • Phone: 520-417-1163
  • Fax: 520-417-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number24241
License Number StateAZ

VIII. Authorized Official

Name: MS. CAROLYN HARE
Title or Position: MANAGER
Credential: R.N.
Phone: 520-417-1163