1285829176 NPI number — AINE P MCKENZIE MD

Table of content: AINE P MCKENZIE MD (NPI 1285829176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285829176 NPI number — AINE P MCKENZIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENZIE
Provider First Name:
AINE
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'BRIEN
Provider Other First Name:
AINE
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285829176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4031 W PLANO PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-5619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-985-1072
Provider Business Mailing Address Fax Number:
972-596-5382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4031 W PLANO PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-5619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-985-1072
Provider Business Practice Location Address Fax Number:
972-596-5382
Provider Enumeration Date:
09/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  M6284 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081S0010X , with the licence number: M6284 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8CR154 . This is a "BCBS TX 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: M6284 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB117532 . This is a "MEDICARE PART B - EFFECT 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00913355 . This is a "MEDICARE RAILROAD - EFFECT 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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