1326293135 NPI number — MCLANE BRIAN, LLC

Table of content: (NPI 1326293135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326293135 NPI number — MCLANE BRIAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLANE BRIAN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY FIRST HOMECARE OF SOUTHERN ILLINOIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326293135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2203 N LOIS AVE STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-850-0042
Provider Business Mailing Address Fax Number:
813-850-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1999 WABASH AVE STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62704-5374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
8-853-5292
Provider Business Practice Location Address Fax Number:
855-830-5482
Provider Enumeration Date:
11/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DE JESUS
Authorized Official First Name:
EMMA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
813-850-0042

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com