Basic Information
| Provider Information | |||||||||
| NPI: | 1295739159 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLAUGHRY | ||||||||
| FirstName: | PATRICK | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13616 CALIFORNIA ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681545335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024960404 | ||||||||
| FaxNumber: | 4024960517 | ||||||||
| Practice Location | |||||||||
| Address1: | 13616 CALIFORNIA ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681545335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024960404 | ||||||||
| FaxNumber: | 4024960517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 882 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 34831 | 01 | NE | BCBS | OTHER | 970012362 | 01 | NE | RAILROAD MEDICARE | OTHER | 47081304012 | 05 | NE | MEDICAID | 68154A019 | 01 | NE | TRICARE | OTHER |