1518280072 NPI number — BRAD A. MCKENZIE

Table of content: (NPI 1518280072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518280072 NPI number — BRAD A. MCKENZIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAD A. MCKENZIE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518280072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELCHES
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97067-0293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-622-3085
Provider Business Mailing Address Fax Number:
503-622-3753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24540 E WELCHES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELCHES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-622-3085
Provider Business Practice Location Address Fax Number:
503-622-3753
Provider Enumeration Date:
03/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MCKENZIE
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
503-622-3085

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D7819 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1285634097 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com