JODY MACK PA NPI 1760663140

NPI Information

  • NPI: 1760663140
  • Provider Name: JODY MACK, PA
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 947 S 5TH ST
    MONTROSE, CO
    ZIP 81401
  • Phone: (970) 249-2421

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NPI Details

Jody Mack, PA is a medical physician assistant in Montrose, CO. Jody Mack, PA NPI is 1760663140. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

947 S 5TH ST
MONTROSE, CO
ZIP 81401-716
Phone: (970) 249-2421
Fax: (970) 249-1203

The NPI 1760663140 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 11/14/2007 and was last updated on 3/3/2022.

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
1363A00000XPhysician Assistant2457COLORADONo
2363AM0700XPhysician AssistantMedicalMED-PAC-LIC-61430MONTANAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
167538746MEDICAIDCOLORADO

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: 11/21/2025

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