Provider Demographics
NPI:1497944607
Name:CHARLES S. MCCLUNG SR., DO
Entity Type:Organization
Organization Name:CHARLES S. MCCLUNG SR., DO
Other - Org Name:MCCLUNG HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:304-647-9971
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-4849
Mailing Address - Country:US
Mailing Address - Phone:304-647-9971
Mailing Address - Fax:304-647-9973
Practice Address - Street 1:226 SKYLAR DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9383
Practice Address - Country:US
Practice Address - Phone:304-647-9971
Practice Address - Fax:304-647-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5630417000Medicaid
WV5630417000Medicaid
WVG04822Medicare UPIN