Provider Demographics
NPI:1013012517
Name:THE MCKENZIE CLINIC, P.A.
Entity Type:Organization
Organization Name:THE MCKENZIE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, FNP
Authorized Official - Phone:903-843-5676
Mailing Address - Street 1:710 TITUS ST
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-1739
Mailing Address - Country:US
Mailing Address - Phone:903-843-5676
Mailing Address - Fax:903-843-5204
Practice Address - Street 1:710 TITUS ST
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-1739
Practice Address - Country:US
Practice Address - Phone:903-843-5676
Practice Address - Fax:903-843-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4669242OtherAETNA
TX0034JKOtherBLUE CROSS GROUP NUMBER
=========OtherTRICARE
=========OtherCOMMERCIAL INSURERS
4669242OtherAETNA