1922203249 NPI number — BRIAN G. MCELHENY, M.D. LTD

Table of content: (NPI 1922203249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922203249 NPI number — BRIAN G. MCELHENY, M.D. LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN G. MCELHENY, M.D. LTD
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:
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:
1922203249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 W JACKSON ST
Provider Second Line Business Mailing Address:
SUITE # 101
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62901-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-457-6796
Provider Business Mailing Address Fax Number:
618-549-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 W JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE # 101
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-457-6796
Provider Business Practice Location Address Fax Number:
618-549-9799
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCELHENY, M.D. LTD
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
618-457-6787

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036058838 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036058838 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207Q00000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 080007297 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1386603033 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1922203249 . This is a "CORPORATE NPI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 114152 . This is a "HEALTHLINK, INC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3900160 . This is a "BLUE CROSS/BLUE SHEILD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com