Provider Demographics
NPI:1154434124
Name:MAUREEN E MACKEY MD CHARTERED
Entity type:Organization
Organization Name:MAUREEN E MACKEY MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-650-3390
Mailing Address - Street 1:1120 ALMOND TREE LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3229
Mailing Address - Country:US
Mailing Address - Phone:702-650-3390
Mailing Address - Fax:702-650-5864
Practice Address - Street 1:1120 ALMOND TREE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3229
Practice Address - Country:US
Practice Address - Phone:702-650-3390
Practice Address - Fax:702-650-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV42002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC96297Medicare UPIN