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NPI Code Detail

MEDICARE: MACKENZIE SCHACK

MEDICARE: MACKENZIE SCHACK
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
1174400000XSpecialist296675OR

General Provider Information

NPI Number : 1760805451
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE SCHACK
Provider Business Mailing Address
First Line : 3320 SE HOLGATE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3459
Country : US
Telephone Number : 503-231-1411
Fax Number : 503-239-1170
Provider Business Practice Location Address
First Line : 3320 SE HOLGATE BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3459
Country : US
Telephone Number : 503-231-1411
Fax Number : 503-239-1170
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2014
Last Update Date : 01/30/2014

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Directions to “ MACKENZIE SCHACK ” Practice Location

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