Otis L McKinley, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10906 Issued in MI

Practice address

312 E Saginaw St
Au Gres, MI 48703-9637

Phone

(989) 876-7141

Fax

(989) 876-6680

NPI assigned

Jan 8, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225186703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 E SAGINAW ST",
            "city": "AU GRES",
            "state": "MI",
            "postal_code": "487039637",
            "telephone_number": "989-876-7141",
            "fax_number": "989-876-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 E SAGINAW ST",
            "city": "AU GRES",
            "state": "MI",
            "postal_code": "487039637",
            "telephone_number": "989-876-7141",
            "fax_number": "989-876-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINLEY",
        "first_name": "OTIS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "10906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Jo Heinrich, LPC
• Jennifer Tawn Horton, PA-C
• Independence Healthcare Inc. (AuGres Physical Therapy and Rehabilitation)
• Camille Gabriella-Joanne Lutz, PT, DPT
• Scott Arthur McAlindon, DDS
• Melissa Joy Miller
• Mymichigan Medical Center Tawas (Ascension St Joseph Hospital AuGres Family Clinic)
• Mark K Olgaard, DO
• Sleep Right LLC
• Lana Spencer

• General Practice Dentistry in Au Gres, MI
• Providers in Au Gres, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.