Provider Demographics
NPI:1114447083
Name:THE MCINNIS CLINIC PLLC
Entity Type:Organization
Organization Name:THE MCINNIS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:KALOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, AGNP
Authorized Official - Phone:336-342-4286
Mailing Address - Street 1:1123 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5340
Mailing Address - Country:US
Mailing Address - Phone:336-342-4286
Mailing Address - Fax:866-258-0126
Practice Address - Street 1:1123 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5340
Practice Address - Country:US
Practice Address - Phone:336-342-4286
Practice Address - Fax:866-258-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty