1790884559 NPI number — DR. KRISTIN ANN MCCLELAND M.D.

Table of content: ERICA TRUELOVE LAC (NPI 1467150649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790884559 NPI number — DR. KRISTIN ANN MCCLELAND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLELAND
Provider First Name:
KRISTIN
Provider Middle Name:
ANN
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:
SOLSRUD
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790884559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 S MCCLINTOCK DR
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85283-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-831-6800
Provider Business Mailing Address Fax Number:
480-897-2799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 S MCCLINTOCK DR
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-3392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-214-2300
Provider Business Practice Location Address Fax Number:
480-214-2301
Provider Enumeration Date:
09/21/2006

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: 208000000X , with the licence number:  33717 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2Z2762 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 943755 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0787840 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00045508 . This is a "BANNER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9437550 . This is a "DES" identifier . This identifiers is of the category "OTHER".




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