=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710113048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID MICHAEL MCCANCE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2009
-----------------------------------------------------
Last Update Date | 06/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9302 MEDICAL PLAZA DR SUITE B
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-9142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-553-8730
-----------------------------------------------------
Fax | 843-553-8767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9302 MEDICAL PLAZA DR SUITE B
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-9142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-553-8730
-----------------------------------------------------
Fax | 843-553-8767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID M MCCANCE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 843-553-8730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 1233
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------