Provider Demographics
NPI:1134613581
Name:MCCARTY, STANLEY O
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:O
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 BLACKHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-6020
Mailing Address - Country:US
Mailing Address - Phone:303-994-5142
Mailing Address - Fax:
Practice Address - Street 1:5325 BLACKHAWK WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-6020
Practice Address - Country:US
Practice Address - Phone:303-994-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95-097-1501347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle