Individual
MACKENZIE ANNE MCCROREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10000 SE MAIN ST STE 365, PORTLAND, OR 97216-2474
(503) 261-4430
(503) 261-4436
Mailing address
852 SE 59TH AVE, PORTLAND, OR 97215-2001
(312) 925-5903
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085003524
IL
363AS0400X
Surgical Physician Assistant
085003524
IL
363AS0400X
Surgical Physician Assistant
Primary
PA195380
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE (GROUP PTAN)
IL
01
—
206147235
MEDICARE (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAILROAD (GROUP PTAN)
IL
01
—
P01216933
MEDICARE RAILROAD (PROVIDER PTAN)
IL
Enumeration date
07/03/2008
Last updated
01/10/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us