MEDICARE: DR. CELIA S MCCORMICK AU.D.

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
1	231H00000X	Audiologist	51713	TX
2	237600000X	Audiologist-Hearing Aid Fitter	51713	TX

General Provider Information

NPI Number	:	1366415101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CELIA S MCCORMICK AU.D.

Provider Business Mailing Address
First Line	:	4105 W SPRING CREEK PKWY
Second Line	:	SUITE 702
City	:	PLANO
State	:	TX
Zip	:	75024-5283
Country	:	US
Telephone Number	:	972-943-0466
Fax Number	:	972-599-1707

Provider Business Practice Location Address
First Line	:	4105 W SPRING CREEK PKWY
Second Line	:	SUITE 702
City	:	PLANO
State	:	TX
Zip	:	75024-5283
Country	:	US
Telephone Number	:	972-943-0466
Fax Number	:	972-599-1707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	01/21/2011

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