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NPI Code Detail

MEDICARE: MR. KELLY MCCORMICK BC-HIS

MEDICARE: MR. KELLY MCCORMICK BC-HIS
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
1237700000XHearing Instrument SpecialistHAS-P-353618OR
2237700000XHearing Instrument SpecialistHA00002483WA

General Provider Information

NPI Number : 1164552998
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KELLY MCCORMICK BC-HIS
Provider Business Mailing Address
First Line : 1939 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1535
Country : US
Telephone Number : 503-233-6141
Fax Number : 503-233-2889
Provider Business Practice Location Address
First Line : 1939 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-1535
Country : US
Telephone Number : 503-233-6141
Fax Number : 503-233-2889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/19/2013

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Directions to “ MR. KELLY MCCORMICK BC-HIS” Practice Location

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