1043881998 NPI number — MR. HAVEN MACGREGOR MCCLURE APSW

Table of content: MR. HAVEN MACGREGOR MCCLURE APSW (NPI 1043881998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043881998 NPI number — MR. HAVEN MACGREGOR MCCLURE APSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLURE
Provider First Name:
HAVEN
Provider Middle Name:
MACGREGOR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCLURE
Provider Other First Name:
STEVEN
Provider Other Middle Name:
ALLAN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043881998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1517 E HUEBBE PKWY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-1795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-276-4432
Provider Business Mailing Address Fax Number:
608-713-9040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1517 E HUEBBE PKWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53511-1795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-276-4432
Provider Business Practice Location Address Fax Number:
608-713-9040
Provider Enumeration Date:
07/01/2021

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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