Provider Demographics
NPI:1861576878
Name:MCNEVIN, JAMES DIAMOND (MD & DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DIAMOND
Last Name:MCNEVIN
Suffix:
Gender:M
Credentials:MD & DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR FL 5
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-825-6680
Mailing Address - Fax:270-825-7266
Practice Address - Street 1:200 CLINIC DR FL 5
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-825-6680
Practice Address - Fax:270-825-7266
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3876111N00000X
KY57021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100795440Medicaid
KY1882301Medicare ID - Type Unspecified