Mackenzie Lee Mincey, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

26742 Issued in WV

Practice address

110 Sims Circle
Triadelphia, WV 26059-1154

Phone

(304) 599-8000

Fax

(304) 599-8003

NPI assigned

Mar 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Dr. Mackenzie Lee Miller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mincey.mackenzie.031.0480018@ohvmc.meditab.direct-ci.com

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

• Cardinal Pediatrics PLLC

  • Pediatrics Physician
  • Morgantown, WV
  • NPI 1548272651
  NPD (past)

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1659405249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 SUNCREST TOWN CENTRE DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265051876",
            "telephone_number": "304-599-8000",
            "fax_number": "304-599-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SIMS CIRCLE",
            "city": "TRIADELPHIA",
            "state": "WV",
            "postal_code": "260591154",
            "telephone_number": "304-599-8000",
            "fax_number": "304-599-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINCEY",
        "first_name": "MACKENZIE",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "26742",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35127525",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "28153",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0170258",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281536",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659405249",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "MILLER",
            "middle_name": "LEE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathleen Lichwa
• Tammy Lynn Lowe
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• Roger L Menard
• Lisa Miehle, PHARMD
• MKSC Inc. (Marra Knee and Shoulder Center)
• Roger Nicholson
• Lauren Ostapowicz, BA
• Lisa Marie Park, FNP-BC
• Benjamin Arthur Paserba

• Pediatrics Physician in Triadelphia, WV
• Providers in Triadelphia, WV by specialty
• Pediatrics Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; 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.