Provider Demographics
NPI:1063822591
Name:MATTHEW D MCLAREN MD PLLC
Entity Type:Organization
Organization Name:MATTHEW D MCLAREN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLAREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-422-0503
Mailing Address - Street 1:301 SADDLE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8098
Mailing Address - Country:US
Mailing Address - Phone:406-422-0503
Mailing Address - Fax:406-204-0206
Practice Address - Street 1:301 SADDLE DR
Practice Address - Street 2:SUITE F
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8098
Practice Address - Country:US
Practice Address - Phone:406-422-0503
Practice Address - Fax:406-204-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11260261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011004306OtherMEDICARE PTAN