DAVE MACK (NPI# 1376648154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376648154 |
| Entity Type | Individual |
| Full Name | DAVE MACK |
| Practice Address |
1514 Drake St. Madison WI 53711 |
| Practice Telephone | 6082949922 |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | NA | WI | Other Service Providers |
| Street Address |
1514 DRAKE ST. |
| City | MADISON |
| State | WI |
| Zip Code | 53711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487296307 | Exact Sciences Laboratories, LLC | Clinical Medical Laboratory | 650 Forward Drive, Madison, WI 53711 | 2019-10-11 |
| 1508417916 | Cassandra D Pasquariello | Psychologist | Department of Athletics, 1440 Monroe Street, Madison, WI 53711 | 2019-09-26 |
| 1972161628 | Leah Bastian | Marriage & Family Therapist | 2935 S Fish Hatchery Rd # 244, Madison, WI 53711 | 2019-05-29 |
| 1457810673 | Leah Smith | Specialist/Technologist | 1436 Monroe Street, Madison, WI 53711 | 2019-03-18 |
| 1669942249 | Patrick Soltvedt Bohn | Physician Assistant | 1034 Waban Hill, Madison, WI 53711 | 2018-11-27 |
| 1760975395 | Alysha Rolli | Dentist | 2945 Triverton Pike Dr, Fitchburg, WI 53711 | 2018-06-08 |
| 1265922561 | Farence Rogers | Student in an Organized Health Care Education/Training Program | 1475 Engineering Dr. Madison, Madison, WI 53711 | 2018-05-14 |
| 1588015358 | Kristen Siskovich | Speech-Language Pathologist | 2927 Fish Hatchery Rd., Fitchburg, WI 53711 | 2016-06-23 |
| 1598132383 | Shari Eberhardt | Nurse Practitioner | Journey Mental Health Center, 25 Kessel Ct, Madison, WI 53711 | 2015-08-27 |
| 1649646506 | Oak Park Place of Nakoma, LLC | Skilled Nursing Facility | 4327 Nakoma Road, Madison, WI 53711 | 2015-08-14 |
| Find all providers in zip 53711 | ||||
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376721803 | Shannon Jo Shillin | Military Health Care Provider | 5000 W National Ave, Milwaukee, WI 53295-0001 | 2008-02-06 |
| 1699794214 | Gerald Joel Sampica | Military Health Care Provider | 10 Tri Park Way, Appleton, WI 54914-1658 | 2006-07-18 |
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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.