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NPI Code Detail

MEDICARE: DR. WILLIAM RIDGE MCCLINTIC D.O.

MEDICARE: DR. WILLIAM RIDGE MCCLINTIC D.O.
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
1207Q00000XFamily Medicine PhysicianOS003393LPA
2207Q00000XFamily Medicine Physician184734-1NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080173354OTHERNYRR MEDICARE PIN
4CC8362OTHERNYRR MEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285605766
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM RIDGE MCCLINTIC D.O.
Provider Business Mailing Address
First Line : 1 GUTHRIE SQ
Second Line :
City : SAYRE
State : PA
Zip : 18840-1625
Country : US
Telephone Number : 570-888-5858
Fax Number :
Provider Business Practice Location Address
First Line : 1243 PENNSYLVANIA AVE
Second Line :
City : PINE CITY
State : NY
Zip : 14871-9230
Country : US
Telephone Number : 607-734-3929
Fax Number : 607-734-0781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 09/15/2011

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