Healthcare Provider Details

I. General information

NPI: 1952322166
Provider Name (Legal Business Name): MCKENZIE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 S A ST
SPRINGFIELD OR
97477
US

IV. Provider business mailing address

1442 S A ST
SPRINGFIELD OR
97477
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-4100
  • Fax: 541-726-4900
Mailing address:
  • Phone: 541-726-4100
  • Fax: 541-726-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19817
License Number StateOR

VIII. Authorized Official

Name: TODD A HUFFMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 541-726-4100