Basic Information
| Provider Information | |||||||||
| NPI: | 1528218740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JIM MCKINLEY, M.D., PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5701 OLD BULLARD RD | ||||||||
| Address2: | PMB 56 | ||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757034340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037804871 | ||||||||
| FaxNumber: | 8882428720 | ||||||||
| Practice Location | |||||||||
| Address1: | 1814 ROSELAND BLVD | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757014234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037804871 | ||||||||
| FaxNumber: | 8882428720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2008 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCKINLEY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D./OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9037804871 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | H4539 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.