JOHN D MACKENNEY PA NPI 1841472479

NPI Information

NPI: 1841472479
Provider Name: JOHN D MACKENNEY PA

Doing Business As: SPACE COAST FOOT & ANKLE CENTER

Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
6550 N WICKHAM RD STE 4
MELBOURNE, FL
ZIP 32940
Phone: (321) 259-4268
Get Directions

JOHN D MACKENNEY PA is a foot and ankle surgery podiatrist in Melbourne, FL. JOHN D MACKENNEY PA NPI is 1841472479. The provider is registered as an organization entity type.
The provider Is Doing Business As Space Coast Foot & Ankle Center.

The provider's business location address is:

6550 N WICKHAM RD STE 4
MELBOURNE, FL
ZIP 32940-038
Phone: (321) 259-4268

The provider's authorized official is John David Mackenney .
The authorized official title is OWNER PHYSICIANPhysician and has the following contact phone number (321) 259-4268.

The CLIA number assigned to this NPI record is 10D2168974 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/5/2007 and was last updated on 8/9/2011.

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	332B00000X	Durable Medical Equipment & Medical Supplies				No
2	213ES0103X	Podiatrist	Foot & Ankle Surgery	PO3043	FLORIDA	Yes

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
1	5013550001	MEDICARE NSC	FLORIDA
2	U96263	MEDICARE UPIN	FLORIDA
3	340376900	MEDICAID	FLORIDA
4	65811Z	MEDICARE PIN	FLORIDA

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: 5/5/2024

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