MR. CULLEN ANTHONY MACK


Address: 235 E Barnett Rd, Suite 106, Medford, OR 97501-7901
Phone: 5417734029

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 180563 OR Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
DEA MM4142890 01
MEDICAL LICENSE PA180563 01

Office Location

Street Address 235 E BARNETT RD
SUITE 106
City MEDFORD
State OR
Zip Code 97501-7901

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1366069494 Brian Snapp Counselor 1191 Hazel St, Medford, OR 97501 2020-07-06
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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
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Competitor

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City MEDFORD
Zip Code 97501

Improve Information

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Dataset Information

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.

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