MEDICARE: BRIAN L MCELANEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1357913	OTHER	TN	BCBS OF TN

General Provider Information

NPI Number	:	1780638932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN L MCELANEY MD

Provider Business Mailing Address
First Line	:	PO BOX 662
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-0662
Country	:	US
Telephone Number	:	877-833-5034
Fax Number	:	405-948-6507

Provider Business Practice Location Address
First Line	:	4500 MEMORIAL DR
Second Line	:	DEPT RADIOLOGY
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5360
Country	:	US
Telephone Number	:	618-257-9567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/08/2007

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