John D Mackenney PA

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO3043 Issued in FL

Legal business name

JOHN D MACKENNEY PA

Practice address

6550 N Wickham Rd Ste 4
Melbourne, FL 32940-2038

Phone

(321) 259-4268

NPI assigned

Dec 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John David Mackenney, DPMNPI 1770531774

Title

Owner Physician

Phone

(321) 259-4268

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Space Coast Foot & Ankle Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John David Mackenney, DPM

  • Foot & Ankle Surgery Podiatrist
  • Melbourne, FL
  • NPI 1770531774
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1841472479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6550 N WICKHAM RD STE 4",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402038",
            "telephone_number": "321-259-4268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 N WICKHAM RD STE 4",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329402038",
            "telephone_number": "321-259-4268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN D MACKENNEY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "MACKENNEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER  PHYSICIAN",
        "authorized_official_telephone_number": "321-259-4268",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3043",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340376900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Space Coast Foot & Ankle Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nor A Jobarah
• Milan Jockovich, M.D.
• Joe M Creel, DDS, PA
• Joel Scalera DDS PA
• Karl David Johannessen, OD
• John J Bomalaski MD PA
• John J Marcin & Associates PA
• Haig Malcom John, DC
• McKenna E Johns
• Nicole Johns

• Foot & Ankle Surgery Podiatrist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.