MEDICARE: DR. JENNA BETH MACKAY DPM

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	213E00000X	Podiatrist	DP214043	ID
2	213ES0103X	Foot & Ankle Surgery Podiatrist	DP214043	ID

General Provider Information

NPI Number	:	1689029936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA BETH MACKAY DPM

Provider Business Mailing Address
First Line	:	1506 NE WILLIAMSON BLVD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6071
Country	:	US
Telephone Number	:	541-383-3668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 NE WILLIAMSON BLVD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6071
Country	:	US
Telephone Number	:	541-383-3668
Fax Number	:

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

Provider Enumeration Date	:	04/24/2016
Last Update Date	:	01/27/2024

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