Provider Demographics
NPI:1497784268
Name:MCNEIL, KENNETH F (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:MCNEIL
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:PO BOX 3466
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9202
Practice Address - Country:US
Practice Address - Phone:304-720-8816
Practice Address - Fax:904-494-6467
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079799M207LP2900X, 207L00000X
SC22388207LP2900X, 207L00000X
KY25360207L00000X, 207LP2900X
WV16058207LP2900X, 208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207026000Medicaid
WV27005299700OtherWORKERS COMP
WV270052997002OtherTRICARE
MD493000200Medicaid
WV1070936OtherWORKERS COMP
WV270052997OtherMAAC TRI CARE NUMBER
WVP00001152OtherRR MEDICARE
WVDA0096OtherRR MEDICARE
OH2037950Medicaid
WV270052997004OtherTRICARE
WV20554238700OtherWORKERS COMP
WV27005299700OtherWORKERS COMP
WV9333201Medicare PIN
WV20554238700OtherWORKERS COMP
WV27005299700OtherWORKERS COMP
WV20554238700OtherWORKERS COMP
MD493000200Medicaid
WV1070936OtherWORKERS COMP
WV0058890000Medicaid
WV27005299700OtherWORKERS COMP
WVE60339Medicare UPIN
WV001713622OtherBCBS AAP NUMBER
WVP00377016OtherRR MEDICARE
WV0881898Medicare PIN
WV205542387OtherAAP TRI CARE NUMBER
WV9364011Medicare PIN