Provider Demographics
NPI:1841465416
Name:MCILWAIN SERVICES
Entity type:Organization
Organization Name:MCILWAIN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MCILWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-607-3043
Mailing Address - Street 1:8451 FRIAR TUCK WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3842
Mailing Address - Country:US
Mailing Address - Phone:916-248-4029
Mailing Address - Fax:916-961-6598
Practice Address - Street 1:8451 FRIAR TUCK WAY
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3842
Practice Address - Country:US
Practice Address - Phone:916-248-4029
Practice Address - Fax:916-961-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631560332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies