Provider Demographics
NPI:1770959611
Name:MCLINICIAN
Entity type:Organization
Organization Name:MCLINICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:401-481-3001
Mailing Address - Street 1:118 CARRS TRL
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:RI
Mailing Address - Zip Code:02827-1808
Mailing Address - Country:US
Mailing Address - Phone:855-883-6286
Mailing Address - Fax:855-883-6286
Practice Address - Street 1:5051 NW 13TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-8650
Practice Address - Country:US
Practice Address - Phone:855-883-6286
Practice Address - Fax:855-883-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty