1295739159 NPI number — PATRICK MCCLAUGHRY PA-C

Table of content: PATRICK MCCLAUGHRY PA-C (NPI 1295739159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295739159 NPI number — PATRICK MCCLAUGHRY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLAUGHRY
Provider First Name:
PATRICK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295739159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13616 CALIFORNIA ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-5335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-496-0404
Provider Business Mailing Address Fax Number:
402-496-0517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13616 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154-5335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-496-0404
Provider Business Practice Location Address Fax Number:
402-496-0517
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  882 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34831 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 970012362 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47081304012 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68154A019 . This is a "TRICARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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