Provider Demographics
NPI:1609987031
Name:MACKEY, SCOTT T (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:MACKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 FRANTZ RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1382
Mailing Address - Country:US
Mailing Address - Phone:614-764-5600
Mailing Address - Fax:614-764-5605
Practice Address - Street 1:6350 FRANTZ RD
Practice Address - Street 2:SUITE E
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1382
Practice Address - Country:US
Practice Address - Phone:614-764-5600
Practice Address - Fax:614-764-5605
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000321296OtherANTHEM BC BS
OH311070934OtherTAX ID FOR OTHER PLANS
OH000000321296OtherUNICARE
OH311070934OtherTAX ID UNITEDHEALTHCARE
OHF51786Medicare UPIN
OH000000321296OtherANTHEM BC BS