Provider Demographics
NPI:1497942791
Name:L.E. MCNEILL, MD SC
Entity Type:Organization
Organization Name:L.E. MCNEILL, MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MDSC
Authorized Official - Phone:217-348-8727
Mailing Address - Street 1:506 W LINCOLN AVE
Mailing Address - Street 2:SUITES 200A&B
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2453
Mailing Address - Country:US
Mailing Address - Phone:217-348-8727
Mailing Address - Fax:217-345-7146
Practice Address - Street 1:506 W LINCOLN AVE
Practice Address - Street 2:SUITES 200A&B
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2453
Practice Address - Country:US
Practice Address - Phone:217-348-8727
Practice Address - Fax:217-345-7146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL170260OtherPERSONAL CARE
IL284500Medicare PIN