MEDICARE: JASON C MCCANN C.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
1	222Z00000X	Orthotist

General Provider Information

NPI Number	:	1881952992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON C MCCANN C.O.

Provider Business Mailing Address
First Line	:	3003 S KANSAS EXPY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5969
Country	:	US
Telephone Number	:	417-883-5522
Fax Number	:	417-883-2987

Provider Business Practice Location Address
First Line	:	3003 S KANSAS EXPY
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5969
Country	:	US
Telephone Number	:	417-883-5522
Fax Number	:	417-883-2987

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/26/2012

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