Provider Demographics
NPI:1699359679
Name:MCILVAIN, JOHN WICK
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WICK
Last Name:MCILVAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. LUKE'S COVENTRY FAMILY PRACTICE
Mailing Address - Street 2:755 MEMORIAL PARKWAY, SUITE 300
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-847-3300
Mailing Address - Fax:908-847-2289
Practice Address - Street 1:ST. LUKE'S COVENTRY FAMILY PRACTICE
Practice Address - Street 2:755 MEMORIAL PARKWAY SUITE 300
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865
Practice Address - Country:US
Practice Address - Phone:908-847-3300
Practice Address - Fax:908-847-2289
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program