Provider Demographics
NPI:1376812131
Name:MARK R MCCLUNG MD PC
Entity Type:Organization
Organization Name:MARK R MCCLUNG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-728-5878
Mailing Address - Street 1:1200 5TH AVE
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3132
Mailing Address - Country:US
Mailing Address - Phone:206-728-5878
Mailing Address - Fax:206-728-5876
Practice Address - Street 1:1200 5TH AVE
Practice Address - Street 2:SUITE 2010
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3132
Practice Address - Country:US
Practice Address - Phone:206-728-5878
Practice Address - Fax:206-728-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0032789261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)