Healthcare Provider Details

I. General information

NPI: 1821296294
Provider Name (Legal Business Name): ANDY MACKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 NW WAUKOMIS
NORTHMOOR MO
64151
US

IV. Provider business mailing address

8011 NE 111TH TER
KANSAS CITY MO
64157-8813
US

V. Phone/Fax

Practice location:
  • Phone: 816-721-2747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: