MEDICARE: JAMES A MCKINNEY DO

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	208D00000X	General Practice Physician	N3174	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	275004YYN	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1861571614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A MCKINNEY DO

Provider Business Mailing Address
First Line	:	5009 UNIVERSITY AVE
Second Line	:	STE C
City	:	LUBBOCK
State	:	TX
Zip	:	79413-4432
Country	:	US
Telephone Number	:	254-634-6999
Fax Number	:	254-200-4099

Provider Business Practice Location Address
First Line	:	3201 S AUSTIN AVE
Second Line	:	STE 255
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-7545
Country	:	US
Telephone Number	:	512-763-4325
Fax Number	:	512-763-4324

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/21/2022

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Directions to “ JAMES A MCKINNEY DO” Practice Location

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