Provider Demographics
NPI:1396959417
Name:VERNON T MACKEY PC
Entity type:Organization
Organization Name:VERNON T MACKEY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:T
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-977-6700
Mailing Address - Street 1:9191 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE D-101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4270
Mailing Address - Country:US
Mailing Address - Phone:623-977-6700
Mailing Address - Fax:623-977-6771
Practice Address - Street 1:9191 W THUNDERBIRD RD
Practice Address - Street 2:SUITE D-101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4270
Practice Address - Country:US
Practice Address - Phone:623-977-6700
Practice Address - Fax:623-977-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3535207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ04999Medicare ID - Type UnspecifiedSUBMITTER ID #
AZZ85778Medicare ID - Type UnspecifiedINDIVIDUAL #
AZZ85776Medicare ID - Type UnspecifiedGROUP #
AZD47266Medicare UPIN