Provider Demographics
NPI:1790800548
Name:MACKEY FAMILY PRACTICE OF BEAR, P.A.
Entity Type:Organization
Organization Name:MACKEY FAMILY PRACTICE OF BEAR, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-838-2199
Mailing Address - Street 1:258 FOX HUNT DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2536
Mailing Address - Country:US
Mailing Address - Phone:302-838-2199
Mailing Address - Fax:302-838-2135
Practice Address - Street 1:258 FOX HUNT DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2536
Practice Address - Country:US
Practice Address - Phone:302-838-2199
Practice Address - Fax:302-838-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000711401Medicaid
DE0000711401Medicaid