1861616658 NPI number — COURTNEY ARRON MCCLURE DC

Table of content: (NPI 1306849450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861616658 NPI number — COURTNEY ARRON MCCLURE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLURE
Provider First Name:
COURTNEY
Provider Middle Name:
ARRON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1861616658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
08/08/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 WARREN DRIVE
Provider Second Line Business Mailing Address:
PO BOX 646
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45644-0646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-438-3080
Provider Business Mailing Address Fax Number:
740-642-4156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 WARREN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45644-0646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-642-4154
Provider Business Practice Location Address Fax Number:
740-642-4156
Provider Enumeration Date:
04/12/2007

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: 111NI0013X , with the licence number:  2739 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22000000162917 . This is a "ABSC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4497404 . This is a "UNITED HEALTHCARE INSUR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2450629 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2160870 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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