Provider Demographics
NPI:1447465117
Name:MICHAEL MCKINNEY, M.D. PA
Entity type:Organization
Organization Name:MICHAEL MCKINNEY, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:928-634-5700
Mailing Address - Street 1:203 S CANDY LN STE 2A
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4172
Mailing Address - Country:US
Mailing Address - Phone:928-634-5700
Mailing Address - Fax:928-634-8115
Practice Address - Street 1:203 S CANDY LN STE 2A
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4172
Practice Address - Country:US
Practice Address - Phone:928-634-5700
Practice Address - Fax:928-634-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24574207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ403965OtherAHCCCS
AZC19177Medicare UPIN
AZ115080Medicare PIN