MEDICARE: DR. JILLIAN MIRIAH MCCAGG M.D.

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	208600000X	Surgery Physician	24504	WV
2	2086S0102X	Surgical Critical Care Physician	24504	WV

General Provider Information

NPI Number	:	1467679431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILLIAN MIRIAH MCCAGG M.D.

Provider Business Mailing Address
First Line	:	1600 MEDICAL CENTER DR STE 2500
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3657
Country	:	US
Telephone Number	:	304-691-1200
Fax Number	:	304-691-1287

Provider Business Practice Location Address
First Line	:	1600 MEDICAL CENTER DR STE 2500
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3657
Country	:	US
Telephone Number	:	304-691-1200
Fax Number	:	304-691-1287

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	12/01/2014

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