| Jim Mckinley, M.d., Pllc | |
|
1814 Roseland Blvd Tyler TX 75701-4234 | |
| (903) 780-4871 | |
| (888) 242-8720 |
| Full Name | Jim Mckinley, M.d., Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1814 Roseland Blvd, Tyler, Texas |
| Authorized Official Name and Position | James Wayne Mckinley (M.D./OWNER) |
| Authorized Official Contact | 9037804871 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jim Mckinley, M.d., Pllc 5701 Old Bullard Rd Pmb 56 Tyler TX 75703-4340 Ph: (903) 780-4871 | Jim Mckinley, M.d., Pllc 1814 Roseland Blvd Tyler TX 75701-4234 Ph: (903) 780-4871 |
| NPI Number | 1528218740 |
|---|---|
| Provider Enumeration Date | 09/24/2008 |
| Last Update Date | 01/05/2011 |
| Medicare PECOS PAC ID | 3476616210 |
|---|---|
| Medicare Enrollment ID | O20090106000229 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528218740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | H4539 (Texas) | Primary |
| Provider Name | James Wayne Mckinley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902896863 PECOS PAC ID: 3072586551 Enrollment ID: I20040813000297 |
| Provider Name | Laura C Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942228937 PECOS PAC ID: 4587614391 Enrollment ID: I20050129000098 |
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