Provider Demographics
NPI:1093866071
Name:MCLD CORPORATION
Entity Type:Organization
Organization Name:MCLD CORPORATION
Other - Org Name:DOWNTOWN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:TUETKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:319-465-4906
Mailing Address - Street 1:207 2ND AVE SE
Mailing Address - Street 2:STE A
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1238
Mailing Address - Country:US
Mailing Address - Phone:319-221-1050
Mailing Address - Fax:319-221-1053
Practice Address - Street 1:207 2ND AVENUE SE STE A
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403
Practice Address - Country:US
Practice Address - Phone:319-221-1050
Practice Address - Fax:319-221-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1281332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0480913Medicaid
IA0480913Medicaid