Provider Demographics
NPI:1003372624
Name:MCCLOUD HEALTHCARE CLINIC, INC.
Entity Type:Organization
Organization Name:MCCLOUD HEALTHCARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-964-2389
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:MCCLOUD
Mailing Address - State:CA
Mailing Address - Zip Code:96057-1143
Mailing Address - Country:US
Mailing Address - Phone:530-964-2389
Mailing Address - Fax:
Practice Address - Street 1:828 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2137
Practice Address - Country:US
Practice Address - Phone:530-926-4528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCLOUD HEALTHCARE CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty