Mack, John Edward

Mack, John Edward is an individual health care provider with primary practice located at 70 Medical Center Cir Ste 213 , Fishersville VA 22939-2273. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Mack, John Edward can be contacted via phone (540) 245-7705.

Contact Information

Primary practice address
70 Medical Center Cir Ste 213 Fishersville VA 22939-2273
Phone: (540) 245-7705
Fax: (540) 245-7710
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 0110006808 Virginia
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 006239 New York
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 006239 New York

Profile Details

NPI number 1619918968
LBN Legal business name Mack, John Edward
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Jun 22nd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619918968 NPPES
New York MEDICAID 01908396

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