Provider Demographics
NPI:1639358518
Name:PAUL MACKELL MD PC
Entity Type:Organization
Organization Name:PAUL MACKELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-666-4606
Mailing Address - Street 1:588 US HIGHWAY 287 STE 204
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2615
Mailing Address - Country:US
Mailing Address - Phone:303-666-4606
Mailing Address - Fax:303-666-4610
Practice Address - Street 1:588 US HIGHWAY 287 STE 204
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2615
Practice Address - Country:US
Practice Address - Phone:303-666-4606
Practice Address - Fax:303-666-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01253202Medicaid
COC550338Medicare PIN
CO01253202Medicaid