DR. JEREMY MICHAEL MACKO (NPI# 1689966483) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689966483 |
| Entity Type | Individual |
| Full Name | DR. JEREMY MICHAEL MACKO |
| Credential | M.D. |
| Practice Address |
49 Mdg/sgpf 280 First St, Bdg 23 Holloman Afb NM 88330-8273 |
| Practice Telephone | 5755727985 |
| Practice Fax Number | 5755722259 |
| Mailing Telephone | 5755727985 |
| Mailing Fax Number | 5755722259 |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2018-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 01071414A | IN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 20 York Street, Ynhh Department of Radiology and Biomedical Imaging, New Haven, CT 065103220 | (203) 688-4242 |
| Street Address |
49 MDG/SGPF 280 FIRST ST, BDG 23 |
| City | HOLLOMAN AFB |
| State | NM |
| Zip Code | 88330-8273 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598312084 | Zachary James Smith | Pharmacist | 49th Medical Group 280 First Street, Holloman Afb, NM 88330 | 2019-08-20 |
| 1346776804 | Maxilea Isom | Behavior Technician | 2079 Eglin Ave Apt A, Holloman, Afb, NM 88330 | 2017-05-03 |
| 1932558665 | Courtney Davis | Day Training/Habilitation Specialist | 2228 La Luz Pkwy Unit A, Holloman Afb, NM 88330 | 2016-06-03 |
| 1568849255 | Ryan Abner | Registered Nurse | 49th Medical Building 17, Holloman Afb, NM 88330 | 2015-05-01 |
| 1710384292 | United States Air Force | Military Hospital | 49th Medical Bldg 17, Holloman Afb, NM 88330 | 2014-11-26 |
| 1174934764 | Jason Gordon | Social Worker | 1st Street Holloman Afb, Holloman Afb, NM 88330 | 2014-05-16 |
| 1649512807 | Philip Walker | Internal Medicine | 280 1st St, Holloman Afb, Alamogordo, NM 88330 | 2013-03-25 |
| 1275891889 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 551 4th Street, Bldg. 227, Holloman Afb, NM 88330 | 2012-05-02 |
| 1568606317 | Kimberly Dawn Jensen | Internal Medicine | 280 1st St Bldg 15, 49 Mdg Holloman Afb, Holloman Afb, NM 88330 | 2009-04-23 |
| 1700042306 | Bettina Watkins | Family Medicine | 280 First St, Bldg 23, Holloman Afb, NM 88330 | 2008-08-03 |
| Find all providers in zip 88330 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616679 | Gemma Cristina Zapater | General Practice | 923 Calle Fuerte Ne, Albuquerque, NM 87113-2373 | 2020-10-15 |
| 1710596036 | Provider Cares Network LLC | General Practice | 10401 Montgomery Pkwy Ne Ste 1a, Albuquerque, NM 87111-3876 | 2020-07-23 |
| 1154948081 | Designed Health Options, LLC | General Practice | 5065 Corrales Rd., Corrales, NM 87048 | 2020-06-26 |
| 1538714381 | Uyama A Fernandez | General Practice | 400 Gold Ave Sw Ste 220, Albuquerque, NM 87102-3278 | 2019-08-08 |
| 1386180909 | Lisselle Marie Villarrubia Ocasio | General Practice | Msc10 6000 1 University of New Mexico, Albuquerque, NM 87131-5505 | 2017-01-07 |
| 1225586969 | Joan Goldsworthy | General Practice | Unm School of Medicine Msc09 5040, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2016-09-12 |
| 1033568902 | Karen Griest | General Practice | 68 Pinon Trl, Cedar Crest, NM 87008-9444 | 2016-06-10 |
| 1447610886 | Sean T Mcgee | General Practice | Univeristy of New Mexico, Albuquerque, NM 87131-0001 | 2016-02-27 |
| 1275901266 | Lynn Schrader Sweeney | General Practice | 701 Kerney Dr, Farmington, NM 87401-3660 | 2015-09-08 |
| 1942608708 | Marathon Health, Inc. | General Practice | 2208 W Main St, C/o Concho Employee Health Center, Artesia, NM 88210-3720 | 2014-12-10 |
| Find all providers with the same taxonomy | ||||
| City | HOLLOMAN AFB |
| Zip Code | 88330 |
Please comment or provide details below to improve the information on DR. JEREMY MICHAEL MACKO.
| 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.