Provider Demographics
NPI:1316549264
Name:MCCLAIN, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3940
Mailing Address - Country:US
Mailing Address - Phone:406-490-3881
Mailing Address - Fax:
Practice Address - Street 1:407 4TH ST
Practice Address - Street 2:
Practice Address - City:STRATTON
Practice Address - State:OH
Practice Address - Zip Code:43961-7209
Practice Address - Country:US
Practice Address - Phone:406-490-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0345340Medicaid