MEDICARE: MCLANE BRIAN, LLC

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1831184647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLANE BRIAN, LLC

Provider Business Mailing Address
First Line	:	2203 N LOIS AVE STE 700
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2387
Country	:	US
Telephone Number	:	813-850-0042
Fax Number	:	813-850-0043

Provider Business Practice Location Address
First Line	:	10 GLEN ED PROFESSIONAL PARK
Second Line	:
City	:	GLEN CARBON
State	:	IL
Zip	:	62034-3333
Country	:	US
Telephone Number	:	800-853-5292
Fax Number	:	855-230-5482

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	EMMA DE JESUS
Credential	:
Telephone Number	:	813-850-0042

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	11/12/2025

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