Provider Demographics
NPI:1518720036
Name:MCKAY PROFESSIONAL SERVICES PC
Entity Type:Organization
Organization Name:MCKAY PROFESSIONAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RMO
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-412-8078
Mailing Address - Street 1:901 BOREN AVE STE 1940
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3500
Mailing Address - Country:US
Mailing Address - Phone:425-985-2004
Mailing Address - Fax:
Practice Address - Street 1:1211 S GOLD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3715
Practice Address - Country:US
Practice Address - Phone:360-736-5040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCKAY PROFESSIONAL SERVIES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental