Provider Demographics
NPI:1083946362
Name:L. NEAL MCCAIN, M.D, LTD.
Entity Type:Organization
Organization Name:L. NEAL MCCAIN, M.D, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-529-1770
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-1507
Mailing Address - Country:US
Mailing Address - Phone:618-529-1770
Mailing Address - Fax:618-529-1777
Practice Address - Street 1:305 W JACKSON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-529-1770
Practice Address - Fax:618-529-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC39883Medicare UPIN
IL908440Medicare PIN