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KEITH A MACKENZIE DO PC NPI 1396971958


NPI Information

NPI: 1396971958
Provider Name: KEITH A MACKENZIE DO PC

Doing Business As: MACKENZIE DERMATOLOGY

Classification: Dermatology - 207NS0135X
Entity Type: Organization

Specialization: Procedural Dermatology

CLIA Number: 03D2011524

Address:
3190 CLEARWATER DR
PRESCOTT, AZ
ZIP 86305
Phone: (928) 541-1312
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KEITH A MACKENZIE DO PC is a procedural dermatology dermatology in Prescott, AZ. The provider is procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). KEITH A MACKENZIE DO PC NPI is 1396971958. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Mackenzie Dermatology.

The provider's business location address is:

3190 CLEARWATER DR
PRESCOTT, AZ
ZIP 86305-131
Phone: (928) 541-1312
Fax: (928) 541-0002

The provider's authorized official is Jamie Quinn .
The authorized official title is Credentialing/billing Supervisor and has the following contact phone number (928) 541-1312.

The CLIA number assigned to this NPI record is 03D2011524 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 6/9/2009 and was last updated on 10/18/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207NS0135XDermatologyProcedural Dermatology3225ARIZONAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
120138MEDICARE PINARIZONA
2390766MEDICAIDARIZONA
3G53808MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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