Provider Demographics
NPI:1114942695
Name:MACKEY, MARK FIELD (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:FIELD
Last Name:MACKEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-4141
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660463367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8134UUOtherBCBS
TX165732210Medicaid
TX165732213Medicaid
P00429638OtherMEDICARE RAILROAD
TX165732206Medicaid
TX165732208Medicaid
TX165732205Medicaid
TX8333UDOtherBCBS TX
TXP01202402OtherRR MEDICARE
TX660463OtherRN LICENSE
87908UOtherBLUE CROSS
TXP00956822OtherRR MEDICARE
TX165732205Medicaid
TXP01202402OtherRR MEDICARE
TX8134UUOtherBCBS
TXTXB150846Medicare PIN