DR. SAMUEL ANDREW MACK MD
NPI 1902646094
Student in an Organized Health Care Education/Training Program in Tyler, TX
About Dr. Samuel Andrew Mack Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. SAMUEL ANDREW MACK MD (NPI 1902646094) is an individual student in an organized health care education/training program in Tyler, Texas and active in the NPI registry since May 2024. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Samuel Andrew Mack Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
TYLER, TX 75701
TYLER, TX 75701
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Samuel Mack's NPI number?
The NPI number for Samuel Mack is 1902646094. It was assigned to this individual provider in the NPPES registry on May 28, 2024.
Where is Samuel Mack located?
Samuel Mack practices at 1000 S Beckham Ave, Tyler, TX 75701. The listed phone number is (903) 597-0351.
What is Samuel Mack's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Samuel Mack enrolled in Medicare?
Yes. Samuel Mack is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Samuel Mack was last updated on May 28, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Samuel Andrew Mack, MD · NPI 1902646094
Student in an Organized Health Care Education/Training Program provider in Tyler, Texas. Individual provider, active in the CMS NPPES registry since May 28, 2024.
## Identity
- **NPI:** 1902646094 (Entity type: Individual)
- **Enumerated:** May 28, 2024
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1000 S BECKHAM AVE, Tyler, TX 75701-1908
- **Phone:** (903) 597-0351
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** May 28, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1902646094) · Data from the CMS NPPES public registry.