Dr. Clark R Mckenzie
Interventional Cardiology Internist - Cardiovascular Disease
450 N New Ballas Rd Ste 270 W
Saint Louis
, Missouri 63195-2632
Dr. Clark R Mckenzie
Interventional Cardiology Internist - Cardiovascular Disease
450 N New Ballas Rd Ste 270 W
Saint Louis
, Missouri 63195-2632
(314) 997-6969
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About
Features
Specialties
- Internist - Cardiovascular Disease
- Interventional Cardiology
Languages spoken
- English
Location
First Address
- Dr. Clark R Mckenzie
- 450 N New Ballas Rd Ste 270 W
- Saint Louis, MO
- Zip : 63195-2632
- Fax : (314) 997-6969
- Phone : (314) 991-6969
Second Address
- Dr. Clark R Mckenzie
- 450 N New Ballas Rd Ste 270 W
- Saint Louis, MO
- Zip : 63195-2632
- Fax : (314) 997-6969
- Phone : (314) 991-6969
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207RC0000X | Internist - Cardiovascular Disease | R4P62 | MO |
| Y | 207RI0011X | Interventional Cardiology | R4P62 | MO |
National Provider Identifier
| NPI | 1073506051 |
|---|---|
| Provider Name | Dr. Clark R Mckenzie |
| First Address | Saint Louis, MO 63195-2632 |
| Second Address | Saint Louis, MO 63195-2632 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/08/2005 |
| Last Update Date | 19/01/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000047049 | MCARE CCL GROUP NUMBER (01) | MO |
| 004013185 | MEDICARE PROV ID AREA 99 (01) | MO |
| 006012762 | MEDICARE PROVIDER ID (01) | |
| 110171721 | RR MEDICARE NUMBER (01) | MO |
| 1124011010 | HHC CATH GROUP NPI (01) | MO |
| 1801889795 | STL GROUP NPI (01) | MO |
| 1881863009 | FARM GROUP NPI (01) | MO |
| CD6536 | RR GROUP 01 (01) | MO |
| CI7050 | RR GROUP 99 (01) | MO |
| F77827 | (02) | MO |
| MA1080 | CCL GROUP NUMBER (01) | MO |
| MA1080001 | CCL INDIVDUAL PROV NUMBER (01) | MO |
| P00275849 | RR CCL GROUP (01) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.