| Doctor Name: | MS. BETHE ANN MACK |
| NPI Number: | 1033236922 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMT |
| License Number: | 11341 |
| Business Practice Address: | 2625 Se Hawthorne Blvd Portland, OR - 972142941 |
| Business Phone Number: | 5032389788 |
| Business Fax Number: | |
| Mailing Address: | 4428 Ne 74th Ave, PORTLAND |
| State: | OR |
| Postal Code: | 97218 |
| Phone Number: | 5034814435 |
| Fax Number: | |
| NPI Enumeration Date: | 03/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | 11341 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |