Provider Demographics
NPI:1568790525
Name:MCELLIGOTT, NEIL GREGORY (RN)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:GREGORY
Last Name:MCELLIGOTT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-1311
Mailing Address - Country:US
Mailing Address - Phone:618-971-6460
Mailing Address - Fax:
Practice Address - Street 1:216 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1026
Practice Address - Country:US
Practice Address - Phone:314-747-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022628163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine