Terrance R Mack, MD
Individual provider Active NPI Family Medicine Physician · Hettinger, ND
NPI 1457445892 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1457445892
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3393 (ND)
- Practice address
- 1000 Highway 12
Hettinger, ND 58639 - Phone
- (701) 567-4561
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1090 | SD | MD | Sports Physician Chiropractor |
| 3393 | ND | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 3393 | ND | Yes |
Addresses
Primary practice location
1000 Highway 12
Hettinger, ND 58639
Mailing address
1100 Highway 12
Hettinger, ND 58639-7533
Phone (701) 567-6130
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0553685 | Medicaid | IA | |
| 10777 | Other | ND BLUE CROSS | |
| 27025 | Other | SIOUX VALLEY | |
| 4999831 | Other | SD WELLMARK | |
| 123993 | Other | WORKERS COMP | |
| 45034068812 | Medicaid | NE | |
| 7776040 | Medicaid | SD | |
| 12565 | Medicaid | ND |
Other providers in Hettinger, ND
- Lantis Enterprises, Inc
- Charlotte Lee
- Paula C Lewis
- Jodi Lindquist
- Laura Lea Lurz Cordes
- Joseph M Mattson
- Cole Miller
- Mark W Nelson
- Linda Nudell
- Erika Pagel
All providers in Hettinger, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.