Provider Demographics
NPI:1134882400
Name:MCCORMICK, JAMES CHRISTOPHER
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:MCCORMICK
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 1:3196 ZIMMERMAN RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9013
Mailing Address - Country:US
Mailing Address - Phone:231-360-5433
Mailing Address - Fax:
Practice Address - Street 1:3196 ZIMMERMAN RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-9013
Practice Address - Country:US
Practice Address - Phone:231-360-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty