MR. MICHAEL KEENE DEMACK PA C S NPI 1043347313

NPI Information

NPI: 1043347313
Provider Name: MR. MICHAEL KEENE DEMACK, PA C S
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: PONDEROSA FAMILY CARE LLC

PECOS Registration: Yes

Address:
806 S PONDEROSA ST
PAYSON, AZ
ZIP 85541
Phone: (928) 468-8603
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MR. Michael Keene Demack, PA C S is a medical physician assistant in Payson, AZ with 25 years of experience. MR. Michael Keene Demack, PA C S NPI is 1043347313. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

806 S PONDEROSA ST
PAYSON, AZ
ZIP 85541-541
Phone: (928) 468-8603
Fax: (928) 468-8625

The NPI 1043347313 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/27/2007 and was last updated on 4/19/2017.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		PA 14934	CALIFORNIA	No
2	363AM0700X	Physician Assistant	Medical	6422	ARIZONA	Yes

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: 11/14/2023

NPI Synchronization or Removal

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