MEDICARE: KEVIN P MCCLURG P.A. - C

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
1	363A00000X	Physician Assistant	PA10002821	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3976MC	OTHER	WA	REGENCE BLUESHIELD
2	423898000	OTHER	WA	GROUP HEALTH COOPERATIVE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245296615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN P MCCLURG P.A. - C

Provider Business Mailing Address
First Line	:	709 W ORCHARD DR
Second Line	:	SUITE 4
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1766
Country	:	US
Telephone Number	:	360-318-8800
Fax Number	:	360-318-1085

Provider Business Practice Location Address
First Line	:	709 W ORCHARD DR
Second Line	:	SUITE 4
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1766
Country	:	US
Telephone Number	:	360-318-8800
Fax Number	:	360-318-1085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	12/15/2010

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