Jack G McCulloch Jr

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

JACK G MCCULLOCH JR

Doing business as

McCulloch's Wide Shoes

Practice address

685 S Brea Blvd
Brea, CA 92821-5308

Phone

(714) 529-6399

Fax

(714) 529-2859

NPI assigned

Nov 20, 2006

Last updated

Apr 11, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Apryl H McCulloch, C.PED.

Title

Co-Owner

Phone

(714) 529-6399

Specialties & licenses 1

Addresses

Other names 1

• McCulloch's Wide Shoes Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1790859585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 S BREA BLVD",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928215308",
            "telephone_number": "714-529-6399",
            "fax_number": "714-529-2859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 S BREA BLVD",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928215308",
            "telephone_number": "714-529-6399",
            "fax_number": "714-529-2859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK G MCCULLOCH JR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "MCCULLOCH",
        "authorized_official_first_name": "APRYL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "714-529-6399",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "C.PED."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McCulloch's Wide Shoes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.