Keith R Mack, M.D.

Primary specialty

Independent Medical Examiner PhysicianTaxonomy code 202C00000X

License

14885 Issued in LA

Practice address

1567 S Range Ave
Denham Springs, LA 70726-5201

Phone

(225) 665-3500

Fax

(225) 665-3518

NPI assigned

Jun 14, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trauma Specialists, Apmc

  • Independent Medical Examiner Physician
  • Denham Springs, LA
  • NPI 1700082229
  NPD (past) Authorized official

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366646937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1567 S RANGE AVE",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707265201",
            "telephone_number": "225-665-3500",
            "fax_number": "225-665-3518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1567 S RANGE AVE",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707265201",
            "telephone_number": "225-665-3500",
            "fax_number": "225-665-3518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KEITH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202C00000X",
            "taxonomy_group": "",
            "desc": "Independent Medical Examiner",
            "state": "LA",
            "license": "14885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• LTD Group LLC
• Dore A Lunsford-Nitzh, BCBA
• Lyfe Counseling Consultation & Training
• Elizabeth Ma
• Essie B Mack, M.T.
• Melissa Magee, RPH
• Jamie Alexandra Maggio
• Magnolia ABA Services LLC
• Magnolia Respiratory & Medical Equipment LLC
• Tonya Maher, RN

• Independent Medical Examiner Physician in Denham Springs, LA
• Providers in Denham Springs, LA by specialty
• Independent Medical Examiner Physician in Louisiana

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.