=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568795292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN S. MCCABE, M.D., APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2009
-----------------------------------------------------
Last Update Date | 09/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 4TH ST BOX 30150
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-8423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-445-9306
-----------------------------------------------------
Fax | 318-445-9307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 4TH ST BOX 30150
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-8423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-445-9306
-----------------------------------------------------
Fax | 318-445-9307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN S MCCABE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 318-445-9306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | MD05196R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------