1013989961 NPI number — DR. EUGENE ROBINSON MCNINCH JR. M.D.

Table of content: DR. EUGENE ROBINSON MCNINCH JR. M.D. (NPI 1013989961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013989961 NPI number — DR. EUGENE ROBINSON MCNINCH JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNINCH
Provider First Name:
EUGENE
Provider Middle Name:
ROBINSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1013989961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 6TH ST
Provider Second Line Business Mailing Address:
BLDG 200H / OB/GYN
Provider Business Mailing Address City Name:
GREAT LAKES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60088-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-688-6101
Provider Business Mailing Address Fax Number:
847-688-2732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 6TH ST
Provider Second Line Business Practice Location Address:
BLDG 200H / OB/GYN
Provider Business Practice Location Address City Name:
GREAT LAKES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60088-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-688-6101
Provider Business Practice Location Address Fax Number:
847-688-2732
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D0009308 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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