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NPI Code Detail

MEDICARE: MATTHEW RICHARD MCCLUSKEY

MEDICARE: MATTHEW RICHARD MCCLUSKEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner26585SC

General Provider Information

NPI Number : 1164161758
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW RICHARD MCCLUSKEY
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 1809 WADE HAMPTON BLVD STE 120
Second Line :
City : GREENVILLE
State : SC
Zip : 29609-4050
Country : US
Telephone Number : 864-522-5000
Fax Number : 864-241-9275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2022
Last Update Date : 07/01/2026

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Directions to “ MATTHEW RICHARD MCCLUSKEY ” Practice Location

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