Active NPI
Joshua J Mackie, CRNA
- Certified Registered Nurse Anesthetist
- Boise, ID
National Provider Identifier
1104055367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RNA755
- Practice address
- 338 E Bannock St
Boise, ID 83712-6207 - Phone
- (208) 336-0895
- Fax
- (208) 338-1796
- NPI assigned
- Jul 9, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RNA755 | ID | Primary |
Addresses
Primary practice location
338 E Bannock St
Boise, ID 83712-6207
Mailing address
338 E Bannock St
Boise, ID 83712-6207
Phone (208) 336-0895
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RNA755 | ID | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247097600000",
"number": "1104055367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "338 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126207",
"telephone_number": "208-336-0895",
"fax_number": "208-338-1796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "338 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126207",
"telephone_number": "208-336-0895",
"fax_number": "208-338-1796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKIE",
"first_name": "JOSHUA",
"middle_name": "J",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-09",
"last_updated": "2009-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "ID",
"license": "RNA755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.