Provider Demographics
NPI:1902223787
Name:MCCLURE MEDICAL PRACTICE, PA
Entity Type:Organization
Organization Name:MCCLURE MEDICAL PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-218-1623
Mailing Address - Street 1:901 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3604
Mailing Address - Country:US
Mailing Address - Phone:620-218-1623
Mailing Address - Fax:620-402-5044
Practice Address - Street 1:901 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3604
Practice Address - Country:US
Practice Address - Phone:620-218-1623
Practice Address - Fax:620-402-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31220207VG0400X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty