Provider Demographics
NPI:1376753632
Name:MCLANE MEDICAL, INC.
Entity Type:Organization
Organization Name:MCLANE MEDICAL, INC.
Other - Org Name:POSH MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-825-1772
Mailing Address - Street 1:140 GATEWAY CIR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4085
Mailing Address - Country:US
Mailing Address - Phone:904-825-1772
Mailing Address - Fax:904-825-1740
Practice Address - Street 1:140 GATEWAY CIR UNIT 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4085
Practice Address - Country:US
Practice Address - Phone:904-825-1772
Practice Address - Fax:904-825-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6616261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty