MR. CULLEN ANTHONY MACK (NPI# 1104369099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104369099 |
| Entity Type | Individual |
| Full Name | MR. CULLEN ANTHONY MACK |
| Credential | P.A. |
| Practice Address |
235 E Barnett Rd Suite 106 Medford OR 97501-7901 |
| Mailing Address |
815 N Central Ave Suite C Medford OR 97501-5873 |
| Practice Telephone | 5417734029 |
| Mailing Telephone | 5417349030 |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2017-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 180563 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | MM4142890 | 01 | |
| MEDICAL LICENSE | PA180563 | 01 |
| Street Address |
235 E BARNETT RD SUITE 106 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97501-7901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366069494 | Brian Snapp | Counselor | 1191 Hazel St, Medford, OR 97501 | 2020-07-06 |
| 1477174761 | Corey Renfree | Counselor | 1191 Hazel Street, Medford, OR 97501 | 2020-04-28 |
| 1669012928 | One of A Kind Therapy LLC | Social Worker | 916 West 10th St #205, Medford, OR 97501 | 2020-01-14 |
| 1265993620 | Star Dialysis LLC | Clinic/Center | 50 Rossanley Dr, Medford, OR 97501 | 2019-03-28 |
| 1962972463 | Karen Elise Roertgen | Counselor | 328 So. Central Ave., Suite 204, Medford, OR 97501 | 2018-11-28 |
| 1316458813 | Rick's Medical Supply, Inc | Durable Medical Equipment & Medical Supplies | 562 Parsons Drive, Suite 114, Medford, OR 97501 | 2017-10-24 |
| 1750807111 | La Clinica Del Valle Family Health Care Center Inc. | Clinic/Center | 821 N Riverside Ave, Medford, OR 97501 | 2017-08-17 |
| 1992229009 | Cassandra Schultz | Massage Therapist | 824 East Jackson, Suite A, Medford, OR 97501 | 2017-07-31 |
| 1972962355 | Robin Clevenger | Peer Specialist | 301 S Ivy St, Medford, OR 97501 | 2016-02-15 |
| 1154706984 | Debbie Diane Orr | Behavioral Analyst | 1024 West 9th Street, Medford, OR 97501 | 2015-07-22 |
| Find all providers in zip 97501 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548867856 | Megan Elaine Stewart | Physician Assistant | 3773 Pinetop Dr, Medford, OR 97504-9638 | 2020-10-08 |
| 1811506355 | Nicholas Fantony | Physician Assistant | 28 Leyden St, Medford, MA 02155-6674 | 2020-07-30 |
| 1033739164 | Giana Brunetti | Physician Assistant | 2 Liverpool Way, Medford, NJ 08055-4023 | 2020-04-18 |
| 1881238087 | Rosivel Flores | Physician Assistant | 853 Old Medford Ave, Medford, NY 11763-3521 | 2019-10-30 |
| 1942844386 | Aileen Yaeger | Physician Assistant | 30 Syracuse Ave, Medford, NY 11763-3621 | 2019-10-29 |
| 1568949477 | Evan Xanthos | Physician Assistant | 1600 Delta Waters Rd Ste 107, Medford, OR 97504-9114 | 2018-07-24 |
| 1053863662 | Mark Thomas Kestner | Physician Assistant | 44 Manning St, Medford, MA 02155-4422 | 2016-10-30 |
| 1972058840 | Victoria Rose Acilio | Physician Assistant | 103 Old Marlton Pike Ste 201, Medford, NJ 08055-8772 | 2016-08-22 |
| 1962896944 | Jeremy Klimar | Physician Assistant | 407 Jesse Ct, Medford, NY 11763-2139 | 2015-03-26 |
| 1952734519 | Richard John Baldev | Physician Assistant | 135 Buffalo Ave, Medford, NY 11763-3710 | 2013-08-18 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.