1861616658 NPI number — COURTNEY ARRON MCCLURE DC

Table of content: COURTNEY ARRON MCCLURE DC (NPI 1861616658)

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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