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General NPI Number Information
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NPI Number | 1386738284
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Entity Type | Organization
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Legal Business Name | MACKEY CLINIC LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 405 SOUTHLAND DR
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-523-0101
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Fax | 859-813-5251
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Provider Business Mailing Address
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Address Line | 405 SOUTHLAND DR
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-523-0101
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Fax | 859-813-5251
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINDA L MACKEY
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Credential | DO
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Telephone | 859-523-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 02452
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License Number State | KY
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