1194741959 NPI number — DR. SHAWN C MCLANE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194741959 NPI number — DR. SHAWN C MCLANE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MCLANE

Provider First Name:

SHAWN

Provider Middle Name:

C

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

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:

1194741959

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/20/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1000 BOULDERS PKWY

Provider Second Line Business Mailing Address:

SUITE 102

Provider Business Mailing Address City Name:

RICHMOND

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23225-5545

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

804-320-4243

Provider Business Mailing Address Fax Number:

804-282-1486

Provider First Line Business Practice Location Address:

6600 W BROAD ST STE 300

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

RICHMOND

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23230-1709

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-320-4243

Provider Business Practice Location Address Fax Number:

804-622-0552

Provider Enumeration Date:

07/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0200X , with the licence number:  0101051660 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RP1001X , with the licence number: 0101051660 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 021792 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 226104 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 005822581 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 226104 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4800263 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 7050829 . This is a "MAMSI PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 94993 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 11996 . This is a "CARENET PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 290011240 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 006895400 . This is a "BLACK LUNG PROVIDER NUMBE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".