Organization
PATOKA VALLEY RADIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY M MCCLURE MD (PRESIDENT)
(812) 481-2240
Entity
Organization
Contact information
Practice address
800 W 9TH ST, JASPER, IN 47546-2514
(812) 482-2345
(812) 481-2241
Mailing address
721 W 13TH ST STE 201, JASPER, IN 47546-1817
(812) 481-2240
(812) 481-2241
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000104980
ANTHEM
IN
05
—
100110910A
—
IN
Enumeration date
08/31/2006
Last updated
07/12/2011
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