Provider Demographics
NPI:1205209152
Name:MCNEIL, EARNEST
Entity Type:Individual
Prefix:
First Name:EARNEST
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 W 77TH ST
Mailing Address - Street 2:APT #1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-2801
Mailing Address - Country:US
Mailing Address - Phone:773-418-9659
Mailing Address - Fax:
Practice Address - Street 1:916 W 77TH ST
Practice Address - Street 2:APT #1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-2801
Practice Address - Country:US
Practice Address - Phone:773-418-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-31
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILM25420371068343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)