Provider Demographics
NPI:1417262288
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:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-260-2001
Mailing Address - Street 1:13241 BARTRAM PARK BLVD
Mailing Address - Street 2:STE 1017
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5212
Mailing Address - Country:US
Mailing Address - Phone:904-260-2001
Mailing Address - Fax:904-260-2010
Practice Address - Street 1:13241 BARTRAM PARK BLVD
Practice Address - Street 2:STE 1017
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5212
Practice Address - Country:US
Practice Address - Phone:904-260-2001
Practice Address - Fax:904-260-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89157208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty