1144341306 NPI number — DR. EMILY MARIE MCCLURE M.D.

Table of content: DR. EMILY MARIE MCCLURE M.D. (NPI 1144341306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144341306 NPI number — DR. EMILY MARIE MCCLURE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLURE
Provider First Name:
EMILY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCLURE SANTALIZ
Provider Other First Name:
EMILY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144341306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 SOMERVILLE RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35601-4340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-355-1216
Provider Business Mailing Address Fax Number:
256-355-1655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 SOMERVILLE RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-4340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-355-1216
Provider Business Practice Location Address Fax Number:
256-355-1655
Provider Enumeration Date:
04/03/2007

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: 207Q00000X , with the licence number:  MD.21689 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051517978 . This is a "BC BS C PLUS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 200284020 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051517978 . This is a "BLUE ADVANTAGE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00093289 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051517978 . This is a "BLUECROSS BLUESHIELD, AL2" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 20028402035601A001 . This is a "TRICARE FOR LIFE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051517978 . This is a "BLUECROSS BLUESHIELD, AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 20028402035601A001 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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