Healthcare Provider Details

I. General information

NPI: 1396873501
Provider Name (Legal Business Name): MCKENZIE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E CLAYTON LN
LOUISA KY
41230-8622
US

IV. Provider business mailing address

270 E CLAYTON LN
LOUISA KY
41230-8622
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-4170
  • Fax: 606-638-0367
Mailing address:
  • Phone: 606-638-4170
  • Fax: 606-638-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number90050642
License Number StateKY

VIII. Authorized Official

Name: MR. DAVID B. MCKENZIE
Title or Position: ADMINISTRATOR
Credential: MBA, CPA
Phone: 606-638-4170