MATHEW MCCULLOUGH (NPI# 1184189425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184189425 |
| Entity Type | Individual |
| Full Name | MATHEW MCCULLOUGH |
| Practice Address |
255 Sw 8th Ave Cedaredge CO 81413-3902 |
| Mailing Address |
19096 Pinon Dr Cedaredge CO 81413-8266 |
| Practice Telephone | 9708563146 |
| Practice Fax Number | 9708564385 |
| Mailing Telephone | 3034340539 |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2020-04-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | PA.0006103 | CO | Allopathic & Osteopathic Physicians |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA.0006103 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 95 Holland St, Lakewood, CO 802261054 | 3034340539 |
| Street Address |
255 SW 8TH AVE |
| City | CEDAREDGE |
| State | CO |
| Zip Code | 81413-3902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942206479 | Danny L Mingus | Physician Assistant | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2005-06-21 |
| 1326648254 | Surface Creek Family Practice PC | Family Medicine | 255 Sw 8th Ave, Cedaredge, CO 81413 | 2020-10-29 |
| 1497242820 | Stephanie Lynn Nickel | Counselor | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2018-04-20 |
| 1285039610 | Shawn Palmer | Physician Assistant | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2014-10-28 |
| 1053625798 | Julie Ann Fournier | Nurse Practitioner | 255 Sw 8th Ave, Surface Creek Family Practice, Cedaredge, CO 81413 | 2010-08-05 |
| 1194925586 | Debra Jo Hillyer | Physician Assistant | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2007-07-23 |
| 1467583450 | Timothy C Meilner | Family Medicine | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2007-03-08 |
| 1093754491 | Kevin L Pulsipher | Family Medicine | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2006-06-04 |
| 1558309005 | Surface Creek Family Practice, PC | Clinic/Center | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2006-06-04 |
| 1659318137 | Eric Anthony Peper | Family Medicine | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2006-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194066910 | Dottie Marie Williams-whitlock | Massage Therapist | 735 S. Grand Mesa Drive, Cedaredge, CO 81413 | 2013-03-04 |
| 1194897447 | Cedaredge Pharmacy Inc. | Pharmacy | 215 W. Main St, Cedaredge, CO 81413 | 2006-11-14 |
| 1972689933 | Kendra Kinney | Social Worker | 195 West Main, Cedaredge, CO 81413 | 2006-10-31 |
| 1245766716 | Essential Embodiment LLC | Home Infusion | 120 W Main St, Suite D, Cedaredge, CO 81413 | 2017-05-03 |
| 1003349093 | John George Breitnauer Jr. | Pharmacist | 215 W Main St, Cedaridge, CO 81413-1044 | 2017-04-06 |
| 1316429848 | Millennium Regenerative Medicine, Inc. | Clinic/Center | 175 E Main St, Cedaredge, CO 81413-3331 | 2018-08-31 |
| 1265633606 | Christin Dawn Hawbaker | Acupuncturist | 175 E Main St, Cedaredge, CO 81413-3331 | 2007-05-31 |
| 1093849564 | Timothy Parker Hawbaker | Acupuncturist | 175 E Main St, Cedaredge, CO 81413-3331 | 2007-03-15 |
| 1346243516 | Terry S Wade | Family Medicine | 255 S Grand Mesa Dr, Cedaredge, CO 81413-3822 | 2005-05-23 |
| 1922060656 | Cedaredge Doctors Office PC | Family Medicine | 255 S Grand Mesa Dr, Cedaredge, CO 81413-3822 | 2006-04-06 |
| Find all providers in zip 81413 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285039610 | Shawn Palmer | Physician Assistant | 255 Sw 8th Ave, Cedaredge, CO 81413-3902 | 2014-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677240 | Monique Minter | Physician Assistant | 5504 Malta St, Denver, CO 80249-8649 | 2020-10-23 |
| 1700430261 | Brianne Tanae Harper | Physician Assistant | 2530 N 8th St Suite 205, Grand Junction, CO 81501 | 2019-08-01 |
| 1013478445 | Robin Elise Feldman | Physician Assistant | 17033 E Dorado Dr, Centennial, CO 80015-3029 | 2019-03-28 |
| 1780141895 | Wendy Mc Bui | Physician Assistant | 1530 S Florence Way Unit 312, Aurora, CO 80247 | 2019-02-25 |
| 1639650252 | Jade Golden | Physician Assistant | 101 Founders Pl Ste 109, Aspen, CO 81611-1476 | 2018-08-22 |
| 1861902157 | Hannah Ellen Martin | Physician Assistant | Children's Hospital Colorado 13123 East 16th Avenue, Box 060, Aurora, CO 80045-0600 | 2017-10-02 |
| 1861901878 | Stephanie J Dyck IIi | Physician Assistant | 3800 North York St, Denver, CO 80205-3540 | 2017-09-21 |
| 1932622719 | Brooke Annette Albert | Physician Assistant | 2801 Youngfield St Ste 150, Golden, CO 80401-0209 | 2017-07-24 |
| 1912433400 | Wendy Miller | Physician Assistant | 4041 E Forbes Ct, Greenwood Village, CO 80121-3943 | 2017-05-03 |
| 1154863249 | Zachary A Hitchcock | Physician Assistant | 1107 S Lemay Ave Ste 240, Fort Collins, CO 80524-3959 | 2016-11-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.