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NPI Code Detail

MEDICARE: MACK J NEAL

MEDICARE: MACK J NEAL
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1265377915
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACK J NEAL
Provider Business Mailing Address
First Line : 1990 FENTON ST APT 13
Second Line :
City : LAKEWOOD
State : CO
Zip : 80214-1646
Country : US
Telephone Number : 505-390-3379
Fax Number :
Provider Business Practice Location Address
First Line : 100 W GRIGGS AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1234
Country : US
Telephone Number : 575-277-9318
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2026
Last Update Date : 04/21/2026

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Directions to “ MACK J NEAL ” Practice Location

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