Provider Demographics
NPI:1528218740
Name:JIM MCKINLEY, M.D., PLLC
Entity Type:Organization
Organization Name:JIM MCKINLEY, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-780-4871
Mailing Address - Street 1:5701 OLD BULLARD RD
Mailing Address - Street 2:PMB 56
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4340
Mailing Address - Country:US
Mailing Address - Phone:903-780-4871
Mailing Address - Fax:888-242-8720
Practice Address - Street 1:1814 ROSELAND BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4234
Practice Address - Country:US
Practice Address - Phone:903-780-4871
Practice Address - Fax:888-242-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4539207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty