MEDICARE: HEYWARD BERNARD MACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	335266	LA
2	207P00000X	Emergency Medicine Physician	95276	SC
3	207P00000X	Emergency Medicine Physician	81699	MN

General Provider Information

NPI Number	:	1477110294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEYWARD BERNARD MACK MD

Provider Business Mailing Address
First Line	:	2700 NAPOLEON AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-6914
Country	:	US
Telephone Number	:	504-897-5907
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 NAPOLEON AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-6914
Country	:	US
Telephone Number	:	504-897-5907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/19/2026

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