PATRICK ANDREW MACKNICK


Address: 1818 Carew St, Suite 250, Fort Wayne, IN 46805-4788
Phone: 2604836448

PATRICK ANDREW MACKNICK (NPI# 1861647000) 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) 1861647000
Entity Type Individual
Full Name PATRICK ANDREW MACKNICK
Credential PA-C
Practice Address 1818 Carew St
Suite 250
Fort Wayne
IN 46805-4788
Mailing Address 1234 E Dupont Rd
Suite 3
Fort Wayne
IN 46825-1545
Practice Telephone 2604836448
Mailing Telephone 2603739965
Enumeration Date 2008-12-01
Last Update Date 2009-11-20
Gender Code M
Is Sole Proprietor N

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
IN ANTHEM 000000614685 01
IN MEDICARE RR P00755205 01

Office Location

Street Address 1818 CAREW ST
SUITE 250
City FORT WAYNE
State IN
Zip Code 46805-4788

Providers in the same location

NPI Name Taxonomy Address Enumeration
1447257795 P. Rao Gummadi Anesthesiology 1818 Carew St, Suite 220, Fort Wayne, IN 46805-4788 2005-07-01
1912393570 Kelly Horn Midwife 1818 Carew St, Suite 300, Fort Wayne, IN 46805-4788 2015-04-10
1295141380 Gynecologic Oncology of Northeast Indiana, LLC Obstetrics & Gynecology 1818 Carew St, Suite 250, Fort Wayne, IN 46805-4788 2014-07-09
1174802649 Matthew L Runyan Psychiatry & Neurology 1818 Carew St, Suite 230, Fort Wayne, IN 46805-4788 2011-08-15
1013169275 Jeri Ann Forrest Social Worker 1818 Carew St, Suite 230, Fort Wayne, IN 46805-4788 2008-10-21
1013179357 Carol Pai Wain Garrean Internal Medicine 1818 Carew St, Suite 260, Fort Wayne, IN 46805-4788 2008-06-27
1922156512 Robert W Miner Psychiatry & Neurology 1818 Carew St, Fort Wayne, IN 46805-4788 2007-01-08
1316011349 Parkview Health System, Inc. Durable Medical Equipment & Medical Supplies 1818 Carew St, Suite 260, Fort Wayne, IN 46805-4792 2006-11-20
1801960596 Parkview Health System, Inc. Durable Medical Equipment & Medical Supplies 1818 Carew St, Suite 240, Fort Wayne, IN 46805-4788 2006-11-17
1508945809 Fort Wayne Urology Inc. Urology 1818 Carew St, Suite 210, Fort Wayne, IN 46805-4788 2006-11-06
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619589546 Connor Gemlick Student in an Organized Health Care Education/Training Program 1918 Carew St., Fort Wayne, IN 46805 2020-08-21
1710464086 S.t.a.r. Care Services Clinic/Center 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 2018-07-19
1083122865 Noel Shafi Counselor 3010 East State Boulevard, Fort Wayne, IN 46805 2018-01-16
1063963627 Toni L Irby Specialist 3219 E State Blvd, Fort Wayne, IN 46805 2016-10-19
1639626211 Logan Schwerer Pharmacist 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 2016-09-01
1063817104 Michale Diane Rothgeb Physical Therapy Assistant 2200 Randollia Dr, Fort Wayne, IN 46805 2014-10-31
1124435789 Julia I. Mcfann Physical Therapist 2200 Randalia Dr, Fort Wayne, IN 46805 2014-07-16
1083036974 Capital Senior Living Properties 4, Inc. Assisted Living Facility 3320 East State Boulevard, Fort Wayne, IN 46805 2014-01-10
1356772396 Alexander James Medical Supply Durable Medical Equipment & Medical Supplies 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 2013-12-02
1043595689 Randy James Jennings Pharmacist 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 2011-10-14
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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
1104438944 Erin R Griffin Physician Assistant 5621 Woodshire Dr Apt 5, Fort Wayne, IN 46835-2959 2020-08-22
1821608209 Rebecca Coker Physician Assistant 5137 Truemper Way Apt 5, Fort Wayne, IN 46835-3252 2020-07-31
1114536844 Amanda Kohl Physician Assistant 5429 River Run Trl # 5, Fort Wayne, IN 46825-6039 2020-07-29
1538778352 Kiersten Michelle Coatney Physician Assistant 3924 Taylor Rd Apt 65, Fort Wayne, IN 46804-1945 2020-07-28
1013366905 Brianna Abbott Physician Assistant 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 2016-06-10
1972890093 Megan Bearman Physician Assistant 3640 New Vision Dr, Suite A, Fort Wayne, IN 46845-1717 2011-07-10
1114211729 Joel A Ruetz Physician Assistant 7619 W Jefferson Blvd, Fort Wayne, IN 46804-4133 2011-06-01
1568617256 Parkview Health System Inc Physician Assistant 11104 Parkview Circle Dr Ste 320, Fort Wayne, IN 46845-1733 2008-11-21
1841441805 Brooke B Kutka Physician Assistant 2512 East Dupont Rd, Suite 200, Fort Wayne, IN 46825-1609 2008-10-08
1265688808 Kali E Veness Physician Assistant 2930 Lake Ave, Fort Wayne, IN 46805-5416 2008-08-14
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Competitor

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City FORT WAYNE
Zip Code 46805

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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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