Provider Demographics
NPI:1912906082
Name:KLUGH, JIMMY ROBERT
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:ROBERT
Last Name:KLUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WASHINGTON RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2765
Mailing Address - Country:US
Mailing Address - Phone:724-225-3627
Mailing Address - Fax:304-598-3630
Practice Address - Street 1:460 WASHINGTON RD
Practice Address - Street 2:SUITE 7
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2765
Practice Address - Country:US
Practice Address - Phone:724-225-3627
Practice Address - Fax:304-598-3630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425430207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKL1689021OtherHIGHMARK BCBS
BK7054517OtherDEA
H54577Medicare UPIN
BK7054517OtherDEA