Active NPI
Dave Mack
- Military Health Care Provider
- Madison, WI
National Provider Identifier
1376648154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- License
- NA
- Practice address
- 1514 Drake St.
Madison, WI 53711 - Phone
- (608) 294-9922
- NPI assigned
- Sep 14, 2006
- 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 |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | NA | WI | Primary |
Addresses
Primary practice location
1514 Drake St.
Madison, WI 53711
Mailing address
1514 Drake St.
Madison, WI 53711
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376648154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1514 DRAKE ST.",
"city": "MADISON",
"state": "WI",
"postal_code": "53711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 DRAKE ST.",
"city": "MADISON",
"state": "WI",
"postal_code": "53711",
"telephone_number": "608-294-9922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "DAVE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "WI",
"license": "NA",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- 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.