Provider Demographics
NPI:1649444282
Name:ROBERT A MACKIN, MD DBA NORTHERN ARIZONA SLEEP LAB
Entity type:Organization
Organization Name:ROBERT A MACKIN, MD DBA NORTHERN ARIZONA SLEEP LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-773-1748
Mailing Address - Street 1:77 W FOREST AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1483
Mailing Address - Country:US
Mailing Address - Phone:928-773-1748
Mailing Address - Fax:928-773-9022
Practice Address - Street 1:77 W FOREST AVE STE 205
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-773-1748
Practice Address - Fax:928-773-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17570291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0257580OtherBLUE CROSS
AZ913807Medicaid
AZMD17570Medicare PIN
AZAZ0257580OtherBLUE CROSS