Provider Demographics
NPI:1790706968
Name:ROBERT TODD MCCLURE MDPC
Entity Type:Organization
Organization Name:ROBERT TODD MCCLURE MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-451-6180
Mailing Address - Street 1:1279 TWELVE STONES XING
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3346
Mailing Address - Country:US
Mailing Address - Phone:615-855-0764
Mailing Address - Fax:
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:STE 150
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3032
Practice Address - Country:US
Practice Address - Phone:615-451-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD321752085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3846902Medicaid
TN3846902Medicaid
G10353Medicare UPIN