Healthcare Provider Details

I. General information

NPI: 1780044735
Provider Name (Legal Business Name): MATTHEW S MCCARTY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SPRING RIDGE DR
SUSANVILLE CA
96130-6100
US

IV. Provider business mailing address

PO BOX 349
LOMA LINDA CA
92354-0349
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number51959
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61470
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA126240
License Number StateCA

VIII. Authorized Official

Name: MATTHEW STEPHEN MCCARTY
Title or Position: PRESIDENT
Credential: MD
Phone: 602-686-1129