Basic Information
| Provider Information | |||||||||
| NPI: | 1912906082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLUGH | ||||||||
| FirstName: | JIMMY | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 WASHINGTON RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153012765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242253627 | ||||||||
| FaxNumber: | 3045983630 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 WASHINGTON RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153012765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242253627 | ||||||||
| FaxNumber: | 3045983630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD425430 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | KL1689021 | 01 | PA | HIGHMARK BCBS | OTHER | BK7054517 | 01 | DEA | OTHER |