Provider Demographics
NPI:1053180075
Name:MCGILL, KEVIN C
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:MCGILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 US ROUTE 60 W
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-1112
Mailing Address - Country:US
Mailing Address - Phone:304-743-8160
Mailing Address - Fax:
Practice Address - Street 1:1707 US ROUTE 60 W
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-1112
Practice Address - Country:US
Practice Address - Phone:304-743-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant