Provider Demographics
NPI:1215114004
Name:MCLAIN MEDICAL ASSOC PC
Entity type:Organization
Organization Name:MCLAIN MEDICAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES VICE PRES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-991-8996
Mailing Address - Street 1:2229 CAHABA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2602
Mailing Address - Country:US
Mailing Address - Phone:205-991-8996
Mailing Address - Fax:205-991-8997
Practice Address - Street 1:2022 BROOKWOOD MEDICAL ASSOC PC
Practice Address - Street 2:2022
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6807
Practice Address - Country:US
Practice Address - Phone:205-877-2555
Practice Address - Fax:205-877-2790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLAIN MEDICAL ASSOC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9639207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH194Medicare PIN