Provider Demographics
NPI:1922203249
Name:BRIAN G. MCELHENY, M.D. LTD
Entity Type:Organization
Organization Name:BRIAN G. MCELHENY, M.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MCELHENY, M.D. LTD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-457-6787
Mailing Address - Street 1:207 W JACKSON ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1408
Mailing Address - Country:US
Mailing Address - Phone:618-457-6796
Mailing Address - Fax:618-549-9799
Practice Address - Street 1:207 W JACKSON ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1408
Practice Address - Country:US
Practice Address - Phone:618-457-6796
Practice Address - Fax:618-549-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058838Medicaid
IL207Q00000XOtherTAXONOMY CODE
IL080007297OtherRAILROAD MEDICARE
IL1386603033OtherINDIVIDUAL NPI
IL1922203249OtherCORPORATE NPI
IL114152OtherHEALTHLINK, INC
IL3900160OtherBLUE CROSS/BLUE SHEILD
IL673112Medicare ID - Type UnspecifiedMEDICARE
IL114152OtherHEALTHLINK, INC