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NPI Code Detail

MEDICARE: DR. RICKY R MCCORMICK D.O.

MEDICARE: DR. RICKY R MCCORMICK D.O.
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
1207Q00000XFamily Medicine Physician3577IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427055375
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICKY R MCCORMICK D.O.
Provider Business Mailing Address
First Line : 1600 1ST ST E
Second Line :
City : INDEPENDENCE
State : IA
Zip : 50644-3155
Country : US
Telephone Number : 319-334-2541
Fax Number : 319-334-7054
Provider Business Practice Location Address
First Line : 1600 1ST ST E
Second Line :
City : INDEPENDENCE
State : IA
Zip : 50644-3155
Country : US
Telephone Number : 319-334-2541
Fax Number : 319-334-7054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 01/07/2021

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