Provider Demographics
NPI:1497235949
Name:MATTHEW MCCLANAHAN APMLLC
Entity Type:Organization
Organization Name:MATTHEW MCCLANAHAN APMLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-535-3781
Mailing Address - Street 1:250 EVANGELINE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1882
Mailing Address - Country:US
Mailing Address - Phone:806-535-3781
Mailing Address - Fax:
Practice Address - Street 1:250 EVANGELINE DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1882
Practice Address - Country:US
Practice Address - Phone:806-535-3781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty