Provider Demographics
NPI:1396491486
Name:MCCLAIN DIAGNOSTIC CO
Entity type:Organization
Organization Name:MCCLAIN DIAGNOSTIC CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/VASCULAR TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:312-678-0677
Mailing Address - Street 1:2343 S SPRINGFIELD AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3047
Mailing Address - Country:US
Mailing Address - Phone:312-678-0677
Mailing Address - Fax:
Practice Address - Street 1:2343 S SPRINGFIELD AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3047
Practice Address - Country:US
Practice Address - Phone:312-678-0512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-27
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty