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

Table of Contents

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