Provider Demographics
NPI:1598950842
Name:ALLAN MACKAY MD PC
Entity Type:Organization
Organization Name:ALLAN MACKAY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-339-5424
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1350
Mailing Address - Country:US
Mailing Address - Phone:812-339-5424
Mailing Address - Fax:812-339-5413
Practice Address - Street 1:100 N CURRY PIKE
Practice Address - Street 2:SUITE A1
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404
Practice Address - Country:US
Practice Address - Phone:812-339-5424
Practice Address - Fax:812-339-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 208VP0014X
01062200A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000537577OtherBLUE CROSS/BLUE SHIELD
IN200830920AMedicaid
INI64918Medicare UPIN
IN000000537577OtherBLUE CROSS/BLUE SHIELD
IN200830920AMedicaid