1962561001 NPI number — MCKANE & ASSOCIATES, PC

Table of content: (NPI 1962561001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962561001 NPI number — MCKANE & ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCKANE & ASSOCIATES, PC
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:
MCKANE AND ASSOCIATES
Provider Other Organization Name Type Code:
4
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:
1962561001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 E MAIN STR
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
ST CHARLES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-377-7226
Provider Business Mailing Address Fax Number:
630-377-8826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 E MAIN ST
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
ST CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60174-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-377-7226
Provider Business Practice Location Address Fax Number:
630-377-8826
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKANE
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
630-377-7226

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0004532166 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com