Provider Demographics
NPI:1093873234
Name:MCKECHNIE, JAMES KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEITH
Last Name:MCKECHNIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9252
Mailing Address - Country:US
Mailing Address - Phone:217-348-1030
Mailing Address - Fax:217-348-1090
Practice Address - Street 1:103 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9252
Practice Address - Country:US
Practice Address - Phone:217-348-1030
Practice Address - Fax:217-348-1090
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058473207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL236090OtherMEDICARE PTAN
IL002811OtherHEALTH ALLIANCE
IL036058473Medicaid
IL791203439OtherRAILROAD MEDICARE
IL133038OtherHEALTHLINK PROVDER ID
IL1515701OtherBLUE SHIELD ID
IL036058473Medicaid