Provider Demographics
NPI:1598842502
Name:CH MCCLURE MD PA
Entity Type:Organization
Organization Name:CH MCCLURE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:936-639-3266
Mailing Address - Street 1:300 N JOHN REDDITT DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-2634
Mailing Address - Country:US
Mailing Address - Phone:936-639-3266
Mailing Address - Fax:936-632-9217
Practice Address - Street 1:300 N JOHN REDDITT DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2634
Practice Address - Country:US
Practice Address - Phone:936-639-3266
Practice Address - Fax:936-632-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C19064Medicare UPIN
00427NMedicare ID - Type Unspecified