Charisse L Mack is a Surgical in Boise, Idaho. Charisse L Mack practices all healthcare services and medical treatments related to Surgical. The NPI Number for Charisse L Mack is 1801973615. The last update date is 2013-03-04.
Charisse L Mack's current location address is 190 E Bannock St, Boise, Idaho. You can contact this provider via phone number 2083812222 and fax number 2083672968. The mailing address for Charisse L Mack is 190 E Bannock St, Boise, Idaho. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Charisse L Mack |
|---|---|
| Address | 190 E Bannock St, Boise, Idaho |
| Phone Number | 2083812222 |
| Fax Number | 2083672968 |
| Sole Proprietor | N |
| Credentials | PA |
NPI Number Detail
| NPI Number | 1801973615 |
|---|---|
| Provider Enumeration Date | 2006-11-01 |
| Last Updated Date | 2013-03-04 |
Provider Mailing Address Detail
| Address | 190 E Bannock St |
|---|---|
| City | Boise |
| State | Idaho (ID) |
| Post Code | 837126241 |
| Phone Number | 2083812222 |
| Fax Number | 2083672968 |
Provider's Primary Taxonomy Detail
| Speciality | Surgical |
|---|---|
| Taxonomy | 363As0400X |
| Licence No | PA632 |
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Definition: A licensed healthcare professional who assists in providing surgical care under physician supervision. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 214786 | ID | STATE OF WA DOL | |
| PAD65 | ID | BLUE CROSS OF ID | |
| 10158697 | ID | BLUE SHIELD OF ID | |
| 807590500 | ID | -- |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Charisse L Mack by the Centers for Medicare & Medicaid Services?
The Charisse L Mack has been issued the NPI (National Provider Identifier) 1801973615, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete street address where Charisse L Mack is physically located?
The Charisse L Mack is physically situated at the following address: 190 E Bannock St, Boise, ID, 837126241.
What is the Charisse L Mack's area of specialization and corresponding taxonomy classification?
The Charisse L Mack's specialty field is Surgical, and it falls under the taxonomy code 363As0400X, which categorizes healthcare providers based on their specialties.
When did the Charisse L Mack receive its 1801973615?
The Charisse L Mack was issued its 1801973615 on 2006-11-01, which is the date when the organization was assigned this unique identifier.
On what date did the Charisse L Mack receive its 1801973615 assignment from the Centers for Medicare & Medicaid Services?
The Charisse L Mack was assigned its 1801973615 by the Centers for Medicare & Medicaid Services on 2006-11-01.